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In a school as crowded as PS 128, it can be tricky to find a space private enough to hold the weekly meetings of the girls' literature club. Today, it's room 317, a typical classroom but special nonetheless to the 12 5th-grade girls who skipped recess to be here.

After she passes out new copies of The Bridge to Tarabithia by Katherine Paterson, Donna A. Gaffney, an assistant professor of clinical nursing at Columbia University's school of nursing, smiles broadly and asks, "Does anyone know what a heroine is?"

One girl raises her hand tentatively and ventures, "A girl hero?"

"That's right," says Gaffney. "You all can be heroines."

In its second year, "Growing Heroines," the club's official title, is a research project into the feasibility of using literature as an intervention tool. Gaffney believes that bibliotherapy, as the approach is called, can be a natural way to encourage preadolescent girls to discuss personal problems that are troubling them.

"The goal is to get them talking about things they would never talk about with teachers or boys around," says Gaffney. "The core is to build self-efficacy, to show them there are goals to want in life, and if you are realistic, you can get them."

The club is open to a limited number of girls in the 3rd, 4th, and 5th grades who have been recommended by their teachers. Teams of Columbia nursing students lead several groups for each grade, gaining valuable field experience and also fulfilling their community-volunteer requirement in the process.

Mellen Lovrin, a psychiatric nurse who graduated last summer, worked with the club last year and saw some of the girls for individual psychotherapy. "The students were so receptive and hungry for attention," she recalls. "It was the best part of my education at Columbia."

Columbia Presbyterian is not the only health institution caught in a socioeconomic waltz with its neighbors. Maintaining good community relations has become crucial to urban teaching hospitals across the country. Children and schools are often a natural entree for these institutions into their surrounding communities.

The University of Colorado in Denver opened three clinics at Denver high schools in 1988 to cope with increasing numbers of uninsured and underinsured school-age children. Now, it operates 10 such clinics. In the past six years, about 7,000 students have made more than 45,000 clinic visits for medical care, mental-health care, and health education.

In 1991, the Johns Hopkins University and Hospital created the office of community health specifically to work with residents in impoverished East Baltimore. It also runs asthma programs in four elementary schools and free health clinics at a nearby high school and middle school. Similarly, Yale New Haven Hospital is involved in educational initiatives with local schools that include career partnerships and scholarships. In 1994, it opened a free clinic at the city's Hillhouse High School.

These efforts and others like them make common sense, observes Phyllis Medvedow, the director of community and government relations for Yale New Haven Hospital. "New Haven is facing serious and devastating problems," she says. "Our success is linked directly to the success of where we are living. Any hospital is foolish not to see this linkage."

"I have a student who raises her hand every single time I ask a question. If I don't call on her, she cries. What can I do?"

"I have a child whose mother was killed over the summer. He follows me everywhere. I know he needs a mother figure, but how can I wean him from me?"

Hungry for advice about how to cope with difficult students, 25 teachers are gathered in the school library at 8 a.m. for a workshop on attention-seeking behavior. Donna A. Gaffney and her colleague, Penny Bushman, both of whom teach at Columbia University's nursing school, seem a bit startled by the range and intensity of the questions this early in the morning.

"I have a child who is completely nonfunctional in school. He is terrified about what is going on at home. How can I teach him to read?"

This extreme fear of leaving home, known as "schoolphobia," is a growing problem with our students, Principal Blanca Battino tells the nurses. Gaffney and Bushman listen carefully and offer the teachers specific suggestions for modifying their students' behavior. Some of the children, they suggest, need further evaluation, and they ask the teachers to make an appointment for the students to visit them at Columbia.

Gaffney started the occasional workshops, covering such topics as stress management and identifying depression in students, on a pilot basis last school year. This year, the sessions are being held once a month.

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