Objective: The internal consistency and construct validity of the North Carolina Family Assessment Scale (NCFAS) are reported. The NCFAS is an instrument designed for family assessment and outcome measurement in family preservation services and child welfare. Method: Internal consistency data from 288 participants cases were analyzed. Construct validity data from 126 participants were analyzed, comparing NCFAS scores with those of the Child Well-Being Scales, the Family Inventory of Resources for Management, and the Index of Family Relations. Results: For the internal consistency component, 3 of 5 original factors were supported, and a fourth factor emerged. Cronbach’s alpha ranged from .71 to .94. For the construct validation component, 5 of 6 relationships were statistically supported, with concurrent validity correlations ranging from .26 to .71. Conclusions: The internal consistency and construct validity of the NCFAS are supported by these findings.

Adverse childhood experiences (ACEs) are a critical determinant and predictor of health across the lifespan. The Appalachian region of the United States, particularly the central and southern portions, experiences worse health outcomes when compared to the rest of the nation. The current research sought to understand the cross-sectional relationships between ACEs, social determinants of health and other health risk factors in one southcentral Appalachian state. Researchers used the 2012 and 2014 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) for analyses. An indicator variable of Appalachian county (n = 29) was used to make comparisons against non-Appalachian counties (n = 71). Analyses further examined the prevalence of ACEs in households with and without children across Appalachian and non-Appalachian regions, and the effects of experiencing four or more ACEs on health risk factors. There were no statistically significant differences between Appalachian and non-Appalachian counties in the prevalence of ACEs. However, compared with adults in households without children, those with children reported a higher percentage of ACEs. Reporting four or more ACEs was associated with higher prevalence of smoking (prevalence ratio [PR] = 1.56), heavy alcohol consumption (PR = 1.69), overweight/obesity (PR = 1.07), frequent mental distress (PR = 2.45), and food insecurity (PR = 1.58) in adjusted models and with fair or poor health only outside Appalachia (PR = 1.65). Residence in an Appalachian county was independently associated with higher prevalence of food insecurity (PR = 1.13). Developing programs and implementing policies aimed at reducing the impact of ACEs could improve social determinants of health, thereby helping to reduce health disparities.

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One state's Title IV-E child welfare social work education collaborative is delineated. This multi-year collaborative between public universities and the state's child welfare system has resulted in funding and field placements for 725 BSW and MSW students in 74 of the state's 100 counties. Further, 589 collaborative graduates have been hired in public child welfare. In addition, beneficial relationships among university personnel, local and state child welfare staff and administrators, and state legislators have enabled this collaborative to continue during difficult economic times. Finally, current challenges, lessons learned, and recommendations for future child welfare social work education initiatives are examined.KEYWORDS Title IV-E funding, public child welfare, child welfare education and training, university and state child welfare partnerships

Rural Appalachia faces extreme poverty-linked hardships, often referred to as ‘social determinants of health'. One social determinant of health often linked with rural poverty is adverse childhood experiences (ACEs). ACEs refer to numerous experiences (e.g., forms of abuse and maltreatment, a dysfunctional household, mental illness in the household, etc.) that one encounters before the age of 18. Local leaders of a county in the heart of Appalachia in northwestern North Carolina (Watauga) embarked on a community level initiative (Watauga Compassionate Community Initiative) aimed at preventing and treating the effects of ACEs and building resiliency. This chapter delves into the academic research related to ACEs and poverty and details the background and ongoing story of the Watauga Compassionate Community Initiative, concluding with lessons learned and insights into what other rural communities can focus on when addressing ACEs, poverty, and other social determinants of health.