Facilitating Student Safety in Communities: Applying an International Model in an Urban U. S. City

Most professional schools now offer internships or externships in which students work with disadvantaged populations, both internationally and within close proximity to the anchor institutions. These placements are often located within underserved or challenged communities with whom the universities or organizations play an important role. In these community-based immersion experiences, students learn pivotal real-life lessons that can be critical to their career development as well as to their development of empathic skills and professional attitudes. Critical to effective learning in these settings are students’ safety and knowledge about the places where they may be working. Student comfort levels are enhanced if these educational institutions are able to adequately prepare them before they begin an internship or externship. This preparation is not only important to the academic and professional success of the student, but it also adds value for the participants and communities where the students will be providing services and learning. Internships often require students to be in new, different, and unfamiliar surroundings, which they may perceive as less safe and secure than those with which they are more familiar. For example, in nursing school education, students most often are placed in hospitals for their clinical rotations. However, for their final clinical rotation, students are required to work in community-based settings, such as a subsidized senior housing complex in a low-income neighborhood. In these settings, students are expected to build supportive relationships with their clients, patients, and/or community members, as part of their learning experience. Working in communities that differ

Most professional schools now offer internships or externships in which students work with disadvantaged populations, both internationally and within close proximity to the anchor institutions. These placements are often located within underserved or challenged communities with whom the universities or organizations play an important role. In these community-based immersion experiences, students learn pivotal real-life lessons that can be critical to their career development as well as to their development of empathic skills and professional attitudes. Critical to effective learning in these settings are students' safety and knowledge about the places where they may be working. Student comfort levels are enhanced if these educational institutions are able to adequately prepare them before they begin an internship or externship. This preparation is not only important to the academic and professional success of the student, but it also adds value for the participants and communities where the students will be providing services and learning.
Internships often require students to be in new, different, and unfamiliar surroundings, which they may perceive as less safe and secure than those with which they are more familiar. For example, in nursing school education, students most often are placed in hospitals for their clinical rotations. However, for their final clinical rotation, students are required to work in community-based settings, such as a subsidized senior housing complex in a low-income neighborhood. In these settings, students are expected to build supportive relationships with their clients, patients, and/or community members, as part of their learning experience. Working in communities that differ greatly from their own, students need to cross new thresholds of learning and explore different ways of interacting in neighborhoods and homes where they are "outsiders" and where they also lack the level of control that they experience in the hospital setting.
Based on a well-known and globally used safety and security model of "acceptance, protection, and deterrence," 1 the University of Maryland, Baltimore (UMB) developed an online orientation for students from across all professional schools on campus, including the schools of Dentistry, Law, Medicine, Nursing, Pharmacy, and Social Work. UMB is located in the southwest section of the city of Baltimore.
In the safety and security model, "acceptance is founded on effective relationships and cultivating and maintaining consent from beneficiaries, local authorities, belligerents, and other stakeholders. This in turn is a means of reducing or removing potential threats in order to access vulnerable populations and undertake program activities." 1,2 Integrating the approach of acceptance, protection, and deterrence in this orientation would improve students' levels of preparation and subsequent adaptation when participating in community-based education and learning. To that end, a series of online modules were proposed, created, and developed with a final production of a 30-minute orientation to Baltimore communities to be provided for all incoming UMB students. These online modules use innovative teaching technologies and video production that are intended to prepare and engage all UMB students, while specifically targeting those who are completing internships in Baltimore offcampus locations.
Taking into consideration more recent global approaches used when training volunteers or personnel going into international settings, a variety of models were explored before deciding which one would be most effective for orienting new UMB students to community-based education and learning experiences. Internationally, after September, 11, 2001 (9/11), US government and international nongovernmental organizations (INGOs) faced challenges regarding whether to continue programs and projects in countries that were perceived as being subject to high safety and security risks, especially as US headlines highlighted the dangers for Americans working overseas. The US Peace Corps was one of the many federal agencies challenged by this change in perceptions of global safety and security. The Peace Corps was founded in 1961 with three distinct goals for individual American volunteers serving in any one of 130 countries. These goals include 1. Helping the people of interested countries in meeting their need for trained volunteers; 2. Helping to promote a better understanding of Americans on the part of the peoples served; and; 3. Helping to promote a better understanding of other peoples on the part of Americans. 3 The overarching goals of the Peace Corps emphasize that volunteers should fully integrate into communities where they serve, in order to 1. Share the volunteer's own culture with that of the host country's family and community; 2. Intimately understand the host environment in order to serve more effectively; and 3. Share this knowledge about the country and the volunteer's own experiences upon returning to the United States.
The Peace Corps strongly encourages that volunteers live with families within the communities they are serving, often in rural areas of countries with limited resources, such as those in North and West Africa, the Middle East, Central Asia, and South America. This approach supports the learning, service, and cultural familiarity of the volunteers.
With significant challenges in security over the past several years and the need for new approaches, the Peace Corps recently was challenged to rethink its strategies for volunteers. The Peace Corps paid devoted attention to how and where volunteers work and live, in order to evaluate if these approaches were still safe. Knowing the effectiveness of integration into communities for volunteers immersed within host communities, the Peace Corps subsequently decided to adapt an existing safety and security framework that was consistent with their global purposes. 4 This decision by the Peace Corps was somewhat controversial because of the common belief that implementing physical and psychological barriers was a key strategy for safety; therefore, implementing an acceptance framework was counterintuitive to some at the time. However, acceptance proved to be an equally effective safety and security strategy that also ensured that the Peace Corps could maintain its core purpose. To this day, the basic acceptance framework drives the Peace Corps as summarized here: "The Peace Corps takes an integrated approach to Volunteer training. Before assignment to the communities where they will live and work, trainees participate in up to 12 weeks of intensive pre-service training in their country of service. Activities often merge language, cross-cultural, health, and safety instruction. . Peace Corps typically places trainees with local families to aid in cultural integration and language acquisition. Trainees develop an awareness of their new environment, build their capacity to cope with the challenges they may face, and practice skills that help them adopt a safe and appropriate lifestyle. Safety and security are predicated on the development of interpersonal relationships between Volunteers and host country community members. Volunteers' daily safety is best assured when they are well-integrated into the local community, valued and protected as extended family members, and viewed as contributors to development. Volunteers are responsible for learning the local language and integrating into their host community, and are expected to build and maintain respectful relationships with sponsoring agency representatives, colleagues, and other community members. These relationships help Volunteers establish a presence in their new homes, pave the way for many work and social opportunities, and become the basis for their support systems in-country." 3 Other INGOs have faced similar challenges. Often their work and mission requires staff members to integrate into local communities and organizations, even in high-risk countries with serious safety concerns. For example, Save the Children, which has offices globally, including locations in the Middle East and South Asia, has developed a safety framework comparable to that of the Peace Corps. The introduction to Save the Children's Safety and Security Manual describes this guiding framework, as follows: "While the degree of risk varies from country to country, safety and security incidents can occur in all operational areas. Crime is widespread in many of the countries in which aid agencies operate, and it is therefore a significant threat to aid workers. More than 50% incidents affecting aid agencies and their staff are associated with crime and banditry. In environments where resources are scarce, the valuable supplies and equipment that agencies controldsuch as food stocks, vehicles or communication equipmentdundoubtedly make them the target of criminal gangs and looters." 5 Save the Children offers safety and security advice that mirrors that of Peace Corps and also draws from the work of Van Brabant. 6 This is evidenced by the following recommendations, excerpted from their employee handbook: "As you build relationships within the communities: Additionally, InterAction, a global association of >180 INGOs, has developed an NGO Safety and Security Training Project Guide for all its member organizations: "The operating landscape has also changed drastically post 9-11, with changes in perceptions about the neutrality of relief and development providers, access challenges, a huge increase in the number of development and humanitarian actors, and expansions of organizational mandates that sometimes create new security challenges. Operating environments have also become increasingly complex and are too often marked by crime and terrorism that affect both aid workers and beneficiaries. INGOs respondents' comments on soft skills reflect the need to think of security as . a social science rather than a precise science. . The importance of teaching, learning and practicing soft skills and ensuing efforts to increase attention to soft skills, correlates with deeper mainstreaming issues concerning security buy-in, implementation and compliance. Skills in persuasion and negotiating, the art of leadership and communication are important, as is paying attention to personal behavior and the common sense of individuals and staff teams, dynamics and cohesion. . Understanding, cultivating and verifying acceptance is increasingly relevant in operational situations." 7

U S S A F E T Y A N D S E C U R I T Y C O N C E R N S
While the global environment has increasingly become more risky, crime rates in the United States have been declining. 8 Yet, 70% of Americans perceive that there is more crime in the United States today than there was even a year ago, rising slightly from the 63% who expressed this viewpoint in 2014. 9 These perceptions about rising violence may be due, in part, to international and national news headlines that have created a sense that it is unsafe at home in the United States and therefore within US communities. Although the average crime rates across the United States have declined, the overall decline in crime is masked by what is occurring in larger urban areas where there are significantly higher crime rates. For example, in 2014, violent crime rates showed 365.5 incidents per 100,000 residents and homicide rates were 4.5 per 100,000. 8 The 10 cities in the United States with the highest crime rates had an average crime rate of 1500 incidents per 100,000, more than 4 times Edwards et al. the national average and Baltimore reported 1334 incidents per 100,000 residents. 10 The 10 cities with the highest homicide rates had an average rate of 30 murders per 100,000 residents, 6.5 times that of the national average; Baltimore reported 33 murders per 100,000 residents, and in recent years this has increased. 10 These data point to the reality that large US cities are less safe than most of the rest of the nation, even as actual crime rates rise and fall. Many US university graduate programs, particularly those in the health sciences, are located in these large metropolitan areas. These universities are in locations that enable health and human sciences graduate and professional programs to offer opportunities for students to work with underserved populations either on campus or in nearby communities. These internships, externships, fellowships, and volunteer programs often are required of graduate professional students to earn the hours necessary to complete their professional degrees, clinical experiences, certifications, and licenses. Therefore, rising safety concerns are relevant for the approximately 42 urban campuses that train students in health and human science graduate and professional programs. As these health sciences campuses seek to improve health equity and address population health on a local level, the need for opportunities to place students in communities will be even more critical in order to effectively educate future health professionals. The Coalition for Urban Serving Universities stated the following: "Health Care Reform has invigorated efforts to reconsider how our nation's health systems should evolve to better meet the health needs of all. Ensuring high-quality care and broader access hinges on our future talentdthe clinicians, researchers, and health leaders who will serve in and shape the future health system. Universities and their academic medical centers have an important role to play. These institutions often serve as 'anchors' for local communities, possessing an unparalleled scale and breadth of resources in education, research, and patient care." 11 The visibility of safety and security issues in urban areas has made some students reluctant to complete community-based internship programs and prompted others to request noncommunity based, or alternate types of internships. University admissions departments are concerned about recruiting students to campuses in urban areas that may be perceived as risky. In effect, graduate and health science university programs are faced with the same dilemma as the Peace Corps and INGOs after 9/11, as their mission requires students to serve in community and neighborhood locations that are often perceived as unsafe. Graduate university programs with community internship mandates are needed to create safety and security strategies that can both ensure student safety, yet still provide students with opportunities to gain necessary in-depth clinical experience delivering direct client and patient services.
UMB is a large urban campus in west Baltimore, located in one of the most underresourced, highest crime, and lowest income areas of the city and state. UMB is home to 6100 students across 6 professional graduate schools: Dentistry, Law, Medicine, Nursing, Pharmacy, and Social Work. Each one of these schools requires students to have multiple hours of direct client and patient contact in many different settings as a component of their professional training. The aforementioned acceptance framework model that is used by international service organizations might be applicable to other US urban universities.
Universities are simultaneously seeking new approaches to improve safety and security, while working to increase local community engagement. Like the Peace Corps volunteers and INGO staff or volunteers going into new environments, many graduate professional students are entering urban areas that are completely unfamiliar and working with population groups as different as those in other parts of the world. The core theme of their fieldbased professional education is not unlike that of those working overseas, where the emphasis of service includes building supportive relationships to facilitate and enhance the learning experience.
To meet this need, we developed, as part of a UMB university team, a 30-minute safety and security orientation video built around the acceptance model, specifically for university students and faculty engaged in community-based activities. However, all university faculty, staff, and students, whether on or off campus, have been encouraged to view the educational module and accompanying video. The UMB leadership was receptive to implementing the acceptance model of safety and security as the orientation framework, although there is no previous example of its use in domestic higher education. This created the opportunity to reframe a university/community safety approach by modifying a safety and security model already well established and implemented by INGOs and agencies engaged in international development work. Based on the acceptance model definition, the UMB orientation module has the following aims: d Increase students' knowledge about the unique characteristics of Baltimore, including the multitude of factors affecting the city's vulnerable communities and underserved populations. d Prepare the professional students for communitybased educational learning, experiences, and activities by listening to the experiences and tips from other interprofessional disciplines. d Increase community engagement by UMB students. d Describe the benefits and opportunities for all who participate in community engagement including the value for students, individual community members, communities, community-based organizations, UMB, and Baltimore. d Encourage community members to understand that the university is committed to supporting ongoing partnerships and collaboration. d Increase student knowledge and skills in safety practices and relationship building to facilitate safe and effective community-based activities.
The 30-minute online orientation, "Baltimore: Be a part of the B'more Story," is an interactive presentation that draws on stories from students, faculty, staff, and community members talking about why they love the city, how they work successfully in the city, and how to stay safe while doing so. To illustrate key points and the overall message, video clips from individual interviews are woven throughout the production. A well-known actor from the Wire and a lifetime city resident, is the narrator. His fame and his willingness to serve as a narrator added a unique dimension to the way the Baltimore story was told in this module. He was also considered a credible voice in the hopes that his narration would students' interest in the module. Throughout the production, Baltimore neighbors and community leaders share what makes Baltimore unique, and offer strategies about how to be involved while staying safe. UMB students, faculty, or staff from each school talk about both living and working in Baltimore. This is all driven toward accepting and embracing the city with it history, culture, vitality, and neighborhood centers. Interspersed with city data relevant to populations with whom students work and information about what makes the city its own cultural hub, the video shares students' own stories of their integration process. One student observed in the video stated, "I walk in the neighborhood like I want to be there. I say hello, ask how they are doing, and stop and chat.
If you act like you don't want to be there, they probably don't want you there either." The video's vision is to promote effective and safe community engagement; its mission is for students to gain new knowledge, increase their perspective, and grow in their affection for Baltimore and thereby be effective when participating in community-based learning. After viewing the video, students should be able to: The structure for the UMB safety and security orientation was drawn from a cross-cultural training framework, 12 based on the acceptance model previously described, and on the integration-based personal safety procedures from safety and security programs from Peace Corps, 3 Catholic Relief Service, 13 InterAction, 7 and other INGOs. The UMB leadership strongly endorsed using this widely accepted international safety and security model to complement the existing security message that UMB security offers; namely "don't use your cell phone in public and don't make eye contact with strangers." This new module reframes the university/community safety approach and pilots a safety and security acceptance model that is already widely accepted internationally. An evaluation plan has been developed and will provide useful information about the impact that this orientation module has on students' knowledge and attitudes about community engagement.

C O N C L U S I O N
The university's strategic plan emphasizes developing and enhancing existing partnerships and relationships with its surrounding communities. Critical to UMB's strategy is this essential need to prepare future professionals to address population health issues via strong relationships with local communities. Given that the directive for developing this module was initiated and supported by UMB's president, as well as various deans, the emphasis and buy-in has been strong across the university. The importance of obtaining initial and subsequent support from leaders, the chief of police for the university, and the communications staff cannot be understated. After reviewing selected models used by INGOs, it was very timely to include this approach in university education. Using these global safety principles and imbedding them within innovative educational technology may be useful for many universities and their campuses. These bestpractice strategies will help future health professionals to develop a variety of skills, which in turn will strengthen relationships between local communities and their anchoring institutions.