Reflections on Participation in Community Outreach Event

By Sarah Willoughby, LCSW, Freeman Health System

On Sunday, Sept 7, 2025, I attended a community outreach event hosted by the Neighborhood Resilience Project in collaboration with McAuley Ministries and the Society of Teachers of Family Medicine (STFM). This was a partnership through the 2025 STFM Conference on Practice & Quality Improvement in Pittsburgh, PA.

I rode to the main site with Marisol Valentin, the director of McAuley Ministries, who told me about the sad history of the Hill District of Pittsburgh and the area’s increased poverty, violence, and other problems. Then we met Father Paul Abernathy, who had the vision to start the Neighborhood Resilience Project—a trauma-informed community development nonprofit.

He provided a tour of the medical/behavioral health facility and led a round table discussion along with one of the McAuley Ministries board members, two volunteer physicians, chief administrator, the nursing director, and the volunteer coordinator. Together, they described their work in revitalizing the Hill community—a neighborhood negatively affected by gentrification.

Father Abernathy and others realized residents of this neighborhood have experienced individual and community trauma, which is affecting their emotional and physical health. I loved their focus “to promote resilient, healing and healthy communities so that people can be healthy enough to sustain opportunities and realize their potential.” I have spent my entire career—35 years—doing this in various rural and urban areas.

During the last 15 years, the Neighborhood Resilience Project has worked with community members, leaders, volunteers, and donors to strengthen the community by focusing on three pillars:

  • Community Support
  • Health and Well-Being
  • Leadership Development

The Neighborhood Resilience Project’s motto is to engage community members to transform them into a resilient, healing, and healthy community. Programs include a free Health Care Center, a Trauma Response Program, a Backpack Feeding Program, and, during the COVID-19 pandemic, a Vaccination Collaborative.

Father Abernathy was working in a predominantly black and underserved community in Pittsburgh and regularly interacting with men, women, and children who had repeatedly experienced multiple forms of trauma. He was a combat veteran of the Iraq War and realized that trauma in the form of hunger, abuse, homelessness, lack of opportunity, racism, lack of health care, and violence greatly informed the worldview and culture of the community.

Understanding that trauma was the greatest barrier facing the development of his community, Father Abernathy began to ask the question, “how do you heal an entire community that has been inundated with trauma for generations?”

Here are some of the Neighborhood Resilience Project’s recent accomplishments:

  1. Through 2021, the organization has helped facilitate more than 2,500 COVID-19 vaccinations, deployed more than 60 times to homicides related to gun violence, provided more than 14,000 items of food and 5,000 clothing items, provided more than $23,000 in emergency relief and document recovery, and had close to 200 volunteer hours through clinicians alone such as to provide free care to the uninsured in the region.
  2. The organization has hosted groups from across the nation who had been previously trained in the Trauma Informed Community Development Framework for a Summit in June 2021.
  3. The organization utilized “Micro-Community Interventions” in the Hill District and saw an improvement in overall well-being as analyzed by the well-being tool, “ImHealthy.”
  4. The organization has renovated its Free Health Center space to double in size and now offers medical and dental care.
  5. In partnership with the Jefferson Regional Foundation, the Neighborhood Resilience Project is rolling out work in the Mon-Valley – first by training one cohort from the McKeesport, Clairton and Duquesne neighborhoods (for a total of three cohorts) in the Trauma Informed Community Development Framework and then coaching those cohorts through the roll-out phase.

Visiting the Neighborhood Resilience Project and meeting key team members was inspiring to me personally and professionally. We’d like our community residents in the Joplin, MO, area to be healthier, and we struggle to find ways to do this. In April, we had a serious storm in our rural area, causing damage to trees, fences, homes, and sheds. Just this week, a woman whose farm is still significantly damaged and whose life has seriously been impacted told her story.

This “Trauma Informed Community Development” (TICD) model in our community might be helpful to Joplin, as many were devastated by the EF5 tornado in 2011 that killed more than 200 people. I plan to meet with someone from the Neighborhood Resilience Project in the next month and learn more about the imHealthy tool and ”micro interventions” we might be able to implement in our community.

Reading in Turbulent Times

By Bill Cayley, MD, MDiv


“Literary experience heals the wound without undermining the privilege of the wound.” —C S Lewis (Goodreads)

In turbulent times, withdrawing to a quiet place with a good book seems more tempting than ever. Escaping to another story, another place, or another time can seem the best refuge from chaos and uncertainty. Yet escaping in reading can also feel like a guilty pleasure when it seems that something should be done. While rest and refuge are important for pacing oneself and avoiding burnout, reading can also provide inspiration as the stories of others give us insight into how they faced turbulence and chaotic change. Perhaps, as we face the current moment, a good book might be just the right thing.

Looking back over recent history, it is hard to think of a more turbulent time than the 1930s and 1940s, when the world learned that the “war to end all wars” (World War I) actually was not. In 1943, Langdon Gilkey was a teacher in China and one of about 2000 expatriates interned at the Weihsien compound for “safety and comfort” during the Japanese occupation of China in World War II. Shantung Compound (HarperCollins) is Gilkey’s story of that experience, as the interned expatriates were essentially left to themselves to organize and run life inside their compound. From dealing with hunger, jealousy, boredom, and fear (and even an exploding egg) to finding ways to make life more civilized and tolerable, the book tells a story of community and humanity in the face of isolation and deprivation. As Gilkey concludes, “Out of apparent evil, new creativity can arise if the meanings and possibilities latent within the new situation are grasped with courage and with faith.”

From World War II also comes the story of Le Chambon, a French village that was the center of a movement which sheltered nearly 5000 people (including more than 3000 Jews) between 1940 and 1944. While many find the stories of Raoul Wallenberg and Oskar Schindler inspiring, most of us are not diplomats or industrial magnates. Lest Innocent Blood Be Shed (HarperCollins) tells the gripping story of how “goodness happened” in Le Chambon as ordinary people daily risked their ordinary lives to overcome an extraordinary evil. As the author concludes his book, he reflects on the way the Chambonnais affected him during his research and writing: “I know now that I want to have a door in the depths of my being, a door that is not locked against the faces of all other human beings. I know that I want to be able to say, from those depths, ‘Naturally, come in, and come in.’”

The biographies of individuals can also motivate us and inform us with the wisdom of others who have trod paths of challenge. In Man’s Search for Meaning (Beacon Press), psychiatrist Viktor Frankl tells his own story of finding meaning in life as he faced the horrors and loss of life in a Nazi concentration camp. Coming to more recent times, the stories of those who fought for civil rights during and since the 1960s provide more than ample inspiration. While nearly all are familiar with Martin Luther King Jr, the name of John Lewis may be less familiar. The great-grandson of an enslaved man, Lewis first aspired to be a preacher, later took part in many central events of the 1960s civil rights movement, and subsequently served 17 terms in the US House of Representatives until his death in 2020. In His Truth Is Marching On (Penguin Random House), Jon Meacham tells the story of Lewis’s decades in public service, shaped by his faith-based belief that one should love one’s neighbor as oneself. Another influential leader shaped by the civil rights movement, family physician David Satcher served as US Surgeon General from 1998 to 2002. My Quest for Health Equity (Johns Hopkins University Press) is Dr Satcher’s autobiographical account of his decades-long work on equity issues through academia and public health.

Finally, at a time when the essence of family medicine seems at risk of being lost amid politics, culture wars, and threats to the integrity of science, stories of others who have walked the path of general (or family) medicine can be grounding. The breadth of medical autobiographies can be overwhelming, but a small sample of noteworthy narratives includes A Fortunate Man (AbeBooks), the story of an English country doctor in the mid–20th century; A Fortunate Woman (AbeBooks), the story of another physician (this time a woman) in the same English rural town; and What Matters in Medicine: Lessons From a Life in Primary Care (University of Michigan Press), Dr David Loxterkamp’s stories from a career in rural Maine.

How to face the current moment? Take a deep breath, take some time for reflection, and consider taking time to find inspiration and wisdom from those who have gone before.

Using While Pregnant

A Life-Changing Knock


By Meheret Mekonnen, MS

The fear of having a newborn taken away—this is a reality for many women who test positive for substances on a urine drug screen during pregnancy. The stigma and complications of substance use disorders are associated with insufficient prenatal care, inadequate nutrition, chronic medical conditions, and domestic violence.¹

Prenatal substance use and neonatal substance exposure have become pressing public health concerns. It is estimated that more than 4.4% of pregnant women in the United States use 1 or more substances during pregnancy.² Opioid use among pregnant women and cases of neonatal abstinence syndrome have risen alarmingly, with a 131% increase in opioid-related diagnoses during delivery hospitalizations from 2010 to 2017.² Each year, approximately 800,000 of the 4.3 million neonates born in the United States are exposed to illicit substances in utero.³ These statistics, along with countless patient testimonials, highlight the critical need for health care professionals to implement screening, brief intervention, and referral to treatment as part of routine care.

One of the many challenges clinicians and institutions face is how to effectively screen pregnant patients. Many facilities still rely on unstandardized substance use screening, often in the form of urine toxicology testing. However, urine drug screens have demonstrated poor positive predictive value and reveal significant disparities in outcomes.⁴ Historically, unstandardized screening and disclosure practices have been shaped by provider bias, particularly against single women with poor psychological, financial, or social functioning; women with delivery complications; Black women; and those receiving care in public health settings.⁵

Leading organizations—including the World Health Organization (WHO), the US Preventive Services Task Force (USPSTF), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the American College of Obstetricians and Gynecologists (ACOG)—strongly recommend standardizing substance use screening as part of comprehensive obstetric care.⁶ Validated screening tools such as the 5Ps (Parents, Peers, Partner, Pregnancy, Past) offer a structured approach to assessing alcohol and substance use during pregnancy.⁷

Critics of universal verbal screening cite concerns about patient honesty, staff burden, and time constraints. Yet, successful models demonstrate that integration into existing clinic workflows, engagement of multidisciplinary stakeholders, and support from institutional leadership can facilitate adoption and acceptance.⁸

More work is needed to address disparities in substance use screening and the broader public health challenge of prenatal substance exposure. However, universal verbal screening is a meaningful step toward building patient trust, mitigating provider bias, and promoting equity in prenatal care.⁹

References

1. Wendell AD. Overview and epidemiology of substance abuse in pregnancy. Clin Obstet Gynecol. 2013;56(1):91–96. Available from: https://journals.lww.com/clinicalobgyn/FullText/2013/03000/Overview_and_Epidemiology_of_Substance_Abuse_in.15.aspx

2. Hirai AH, Ko JY, Owens PL, Stocks C, Patrick SW. Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010–2017. JAMA. 2021;325(2):146–147.

3. Joseph R, Brady E, Hudson ME, Moran MM. Perinatal substance exposure and long-term outcomes in children: a literature review. 2020.

4. Chin JM, Chen E, Wright T, Bravo RM, Nakashima E, Kiyokawa M, et al. Urine drug screening on labor and delivery. Am J Obstet Gynecol MFM. 2022;4(6):100733. doi:10.1016/j.ajogmf.2022.100733

5. Madora M, Wetzler S, Jose A, Bernstein PS. Pregnant and postpartum people with substance use disorders: understanding the obstetrical care provider’s roles and responsibilities. Matern Child Health J. 2022;26(7):1409–1414.

6. Whittaker A. Guidelines for the identification and management of substance use and substance use disorders in pregnancy. By World Health Organization. Geneva, Switzerland: WHO Press; 2014. Drug Alcohol Rev. 2015;34(3):340–341.

7. Hostage JC, Brock J, Craig W, Sepulveda D. Integrating screening, brief intervention and referral to treatment for substance abuse into prenatal care [3L]. Obstet Gynecol. 2018;131:129S–130S.

8. Chasnoff IJ, Wells AM, McGourty RF, Bailey LK. Validation of the 4P’s Plus© screen for substance use in pregnancy. J Perinatol. 2007;27(12):744–748.

9. Ulrich M, Memmo EP, Cruz A, Heinz A, Iverson RE. Implementation of a universal screening process for substance use in pregnancy. Obstet Gynecol. 2021;137(4):695–701.