1. Shepherd Internship Rachel Tullio

2. Little Flower Clinic ●Healthcare for the homeless clinic ●Services ○Visits with a Medical Provider ○Disease/Case Management ○Medication Assistance Programs ○Referrals for Dental Services ○Onsite Mental Health Services ○Referrals for Mental Health/Substance Abuse Services ​ ○ ​ Insurance Enrollment and Eligibility through Kynect ensure access for all people and eliminate health disparities through the provision of quality holistic care Vision:

3. Population ●City of Hazard, Perry County o Hazard: approx. 5,000 residents o Perry County: 28,241 residents ●Poverty Rate: 28.7 % (USA 15.1%) ●Race: 98.7 % white ●Smoking rate: 31% o highest smoking rate of all states Chronic Disease PerryKYUSA Prevalence of Asthma (% adults) 15%13%8.2% Diabetes9%8%11.9% Hypertension40.8%38%32.5%

4. Responsibilities ●shadowed all staff positions at the clinic ●observed patient appointments with APRNs ●worked in community garden program ●mental health home visits with Outreach and Enrollment ●shadowed Family Health Navigator ●community service o Corner Haven Crisis Shelter o Hospice of the Bluegrass

5. Accomplishments ●provides many non-medical resources o food boxes o transportation o kynectors and insurance enrollment ●prevents and alleviates homelessness ●accepts all patients regardless of ability to pay ●strong relationships with patients and community ●case management

6. Observations & Challenges ●Health o understanding food culture, traditional meals,preparation o soda consumption o diabetes, hypertension, and lifestyle choices ●Political Views o President Obama unpopular o perception of Affordable Care Act ●Economy o strong support for coal industry

7. Frontier Nursing Service ●supporting organization that arranged my internship at Little Flower o provided housing and food ●founded by Mary Breckinridge in 1925 ●birthplace of midwifery in United States ●nurses served people of rural Appalachia ●central hospital and outpost clinics ●now a distance education program that trains nurse-midwives, DNPs, advanced nursing degrees

8. My SSLP ●Maggie’s Place o home of hospitality for pregnant women (& their babies up to 6 months) ●Glendale, Arizona ●Director of Donations ●building relationships with the moms

9. Comparisons Little Flower Clinic ●exposure to medical setting and careers in medical field ●focus: provide primary care services ●community service component ●public health background o Community Health Profile o interviews with community members, leaders, and medical staff ●rural environment Maggie’s Place ●office and home setting at the Michael House ●focus: provide love, support, safety, home security to mothers ●little research into health profile of the community ●less rural, 30 minutes outside of Phoenix

10. Understanding Poverty Little Flower Clinic ●transportation problems in a rural area ●policy focus and ACA ●public health issues including smoking, diabetes, hypertension, drug abuse ●diet and exercise habits ●food desert and access and affordability of produce ●homelessness Maggie’s Place ●importance of soft skills and social interaction in job market ●effects of lack of education ●effects of poor or no family support, few mentors ●need for parenting classes, women’s health education ●faith based organization ●homelessness ●substance and alcohol abuse