Showing papers in "Families, Systems, & Health in 2010"

Integrating mental health into primary care within the Veterans Health Administration.

Abstract: The Veterans Health Administration (VHA) has been undertaking a major transformational program of integrating collaborative mental health resources into primary care settings. Key components of the program include colocated collaborative care provided by mental health professionals; care management; and blended programs that combine elements of these two components, whose functions are highly complementary to each other. The program has grown since 2007 from an initiative implementing pilot programs at participating facilities, to a routine expectation of primary care within all VHA medical centers and large community-based outpatient clinics. The national program office supports this VHA initiative in multiple ways, including technical assistance to sites, program and policy development, dissemination of informational tools to facilitate continuous quality improvement, education and training, and partnerships with other existing and emerging VHA programs such as postdeployment health clinics and the patient-centered medical home.

Using Evidence-Based Quality Improvement Methods for Translating Depression Collaborative Care Research Into Practice

Abstract: OBJECTIVE Translating Initiatives in Depression into Effective Solution (TIDES) aimed to translate research-based collaborative care for depression into an approach for the Veterans Health Administration (VA). SITES: Three multistate administrative regions and seven of their medium-sized primary care practices. INTERVENTION Researchers assisted regional leaders in adapting research-based depression care models using evidence-based quality improvement (EBQI) methods. EVALUATION We evaluated model fidelity and impacts on patients. Trained nurse depression care managers collected data on patient adherence and outcomes. RESULTS Among 72% (128) of the 178 patients followed in primary care with depression care manager assistance during the 3-year study period, mean PHQ-9 scores dropped from 15.1 to 4.7 (p < .001). A total of 87% of patients achieved a PHQ-9 score lower than 10 (no major depression). 62% achieved a score lower than six (symptom resolution). Care managers referred 28% (50) TIDES patients to mental health specialty (MHS). In the MHS-referred group, mean PHQ-9 scores dropped from 16.4 to 9.0 (p < .001). A total of 58% of MHS-referred patients achieved a PHQ-9 score lower than 10, and 40%, a score less than 6. Over the 2 years following the initial development phase reported here, national policymakers endorsed TIDES through national directives and financial support. CONCLUSIONS TIDES developed an evidence-based depression collaborative care prototype for a large health care organization (VA) using EBQI methods. As expected, care managers referred sicker patients to mental health specialists; these patients also improved. Overall, TIDES achieved excellent overall patient outcomes, and the program is undergoing national spread.

Spouses use of social control to improve diabetic patients' dietary adherence.

Abstract: We investigated two types of negative and positive social control strategies, warning and encouragement, used by spouses to urge patients with type II diabetes to improve adherence to the diabetic diet Warning refers to things a spouse may say or do to caution the patient about the consequences of eating a poor diet, and encouragement refers to things a spouse may say or do to promote healthier food choices by the patient Our dyadic design (n=109 couples) assessed spouses' use of warning and encouragement (reported by spouses and by patients), as well as patients' reports of dietary adherence Spouses being actively involved in patients' dietary choices was the largest category of open-ended descriptors of both warning and encouragement Both spousal warning and encouragement were associated with patients' adherence to the recommended diabetic diet, with warning associated with poorer adherence and encouragement associated with better adherence Moreover, it was the spouses' perceptions of their own influence attempts, and not patients' reports, that were consequential for patients' adherence Patients' dietary behavior, and ultimately disease management, appears to be best served when the spouse uses more positively toned and less coercive influence attempts

The Behavioral Health Laboratory: building a stronger foundation for the patient-centered medical home.

Abstract: The Veterans Health Affairs is in the process of implementing a new model for the delivery of primary care: The Patient-Centered Medical Home (PCMH). One critical challenge of any PCMH model will be the integration of basic mental health treatment into primary care. Such a mental health integration program must be flexible enough to incorporate new evidence-based treatments as patient demographics and health care needs evolve over time. This paper summarizes the Behavioral Health Laboratory (BHL) care management model, a program already in place in more than 20 Veterans Affairs facilities along with private sector insurance providers, as ideally suited to fill this role in the PCMH. The BHL uses a platform of standardized, software-aided mental health assessments and clinical care managers to deliver evidence-based treatments for depression, anxiety, and substance abuse in primary care settings. The authors review this comprehensive program of screening, assessment, treatment, and referral to specialty care when needed. The BHL program is consistent with the guiding principles of the Patient-Centered Medical Home: applying chronic illness disease management principles to provide more continuous, coordinated, and efficient primary care services to patients with diverse needs. Just as importantly, the authors review how this standardized platform for delivering integrated mental health services provides the flexibility to incorporate novel interventions for a changing population.

Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home.

Abstract: Behavioral healthcare will be an essential piece of meeting the patient-centered medical home (PCMH) principles of easy access and whole person, coordinated, and integrated care as primary care clinics transform themselves into PCMHs. As this transformation occurs, PCMH clinic staff and behavioral health providers must carefully consider how to adapt their operations to include the provision of integrated-collaborative behavioral health services within the PCMH. Without this careful consideration, integrated-collaborative behavioral healthcare will likely fail to reach its full potential. We discuss the operational and clinical components that appear to be important for success when integrating behavioral healthcare into the PCMH.

The White River model of colocated collaborative care: A platform for mental and behavioral health care in the medical home.

Abstract: In the past two decades a great deal of research has demonstrated improved quality of care when mental health care is integrated into primary care. To date, most of the literature has addressed care management for specific mental illnesses. Such programs can be difficult to implement and sustain. We describe a program of "Colocated Collaborative Care," implemented in 2004 that has been sustained and grown over the 6 years since inception. The Primary Mental Health Care clinic at the White River Junction (Vermont) Veterans Affairs Medical Center offers a full spectrum of mental health care that allows 75% of referred patients to receive all of their care within the primary care clinic, thus conserving scarce specialty services for the most complex patients. The clinic is staffed by a therapist and a psychiatrist (or advanced practice nurse) and complemented by care management and health psychology. It makes use of technology to streamline assessment and track outcomes. The clinic provides a mix of care management, specialty expertise and chronic disease management. Originally developed in a capitated health care system, adherence to general principles that guided its development may be useful in any system of care.

Personal social networks and health: conceptual and clinical implications of their reciprocal impact.

Abstract: Social networks affect positively or negatively a person’s health, and a person’s health affects, in turn, the network’s availability. This article discusses this double dynamic, recommends the routine exploration of patients’ social networks, and offers a mapping tool that allows detection of strengths and weaknesses of those processes so as to facilitate interventions that improve the social support’s health-enhancing effect.

Attending to the whole person in the patient-centered medical home: the case for incorporating mental healthcare, substance abuse care, and health behavior change.

Abstract: The foundation of the U.S. healthcare system is faulty, and the consequences have become inescapable (Committee of Quality of Health Care in America, 2001). We are first among nations in spending on healthcare, whether measured in absolute dollars, per capita expenditures, or proportion of our national budget. Yet our citizens are the least healthy in the developed world. (Anderson & Hussey, 2001) Our nation's healthcare system is simply not a high-quality system. This shortfall is serious enough to cause tens of thousands of unnecessary deaths each year and to compromise our capacity for further economic growth (Anderson & Hussey, 2001; Anderson, Frogner, Johns, & Reinhardt, 2006; Macinko, Starfield, & Shi, 2003), yet it ramifies into so many of our political, financial, and social institutions that change is difficult and fraught with serious unintended consequences.

Primary care-mental health integration in healthcare in the Department of Veterans Affairs.

Abstract: DThe U.S. Department of Veterans Affairs(VA) has been undergoing tremendous trans-formation in the past 15 years with regard tothe delivery of health care. This special issuedescribes one aspect of this transformation ofthe largest health system in the U.S.; the sys-tem-wide efforts to integrate mental healthtreatment into the primary care setting inVA. This primary care-mental health inte-gration (PC-MHI) is being accomplishedthrough the central VA system support andimplementation of three primary modelsdeveloped in the Þeld: the White RiverColocated models, the Behavioral HealthLaboratory, and TIDES (Translating Initi-atives in Depression into Effective Solu-tions). The papers in this special issue de-scribe the development of these models, localand regional efforts to prepare medical cen-ters to adapt and implement PC-MHI, andthe impact of the integration on mentalhealth care in these settings. These effortscould represent a national model ofPC-MHI implementation for health caresystems throughout the U.S.Keywords: primary care-mental health in-tegration, primary care, mental health ser-vices, military veterans

The description and evaluation of the implementation of an integrated healthcare model.

Abstract: Two studies were conducted to examine the practical implementation of an integrated health care model in five primary care clinics in the Upstate New York Veterans Affairs (VA) system. The aims of the studies were: (a) to describe the basic clinical elements of the integrated health care service offered by behavioral health providers (BHPs) in the primary care setting, and (b) to evaluate the perceptions of providers and patients regarding integrated health care practices in their primary care clinics. In Study 1, we reviewed 180 electronic medical records of patients who met with a BHP in primary care. In Study 2, we used semistructured interviews and self-report questionnaires to collect information from 46 primary care providers, 12 BHPs, and 140 patients regarding their perceptions of integrated health care in their primary care clinics. Both studies illustrate a useful method for evaluating the practical implementation of integrated health care models.

The relationship among couple relationship quality, physical functioning, and depression in multiple sclerosis patients and partners.

Abstract: Using Engel's biopsychosocial model and family systems theory, this study explored the associations between multiple sclerosis (MS) patient and partner reports of physical functioning, depression, and couple relationship quality. Fifty-four couples recruited from the MS society completed self-report questionnaires about couple relationship quality, demographic data, and physical functioning. In regression analyses, couple relationship quality positively related to MS patient physical functioning and depression negatively related to MS patient physical functioning. Both MS patient and partner reports of couple relationship quality negatively related to depression scores in partners. While MS patient reports of couple relationship quality negatively related to MS patient depressions scores, partner reports of couple relationship quality were not significantly related. Depression and couple relationship quality were associated with MS patient physical functioning. Couples with higher relationship quality may be better able to cope with the stresses of MS. Thus, clinicians and health care providers need to include partners in MS patient treatment. Further research is needed to better explain causality between MS patient physical functioning, depression, and couple relationship quality.

Motivational interviewing in a family-based pediatric obesity program: a case study.

Abstract: Motivational Interviewing (MI) is an effective method for clinicians to guide and support individuals who wish to make complex health behavior changes; however, little research is available to support its use in the treatment of obesity, particularly in family based therapy and multidisciplinary team settings. The objective of this case report is to demonstrate the application of MI within a family based, multidisciplinary treatment program, and provide examples of MI in obesity treatment. We report a case study on the use of MI with behavioral therapy in a pediatric, family based, multidisciplinary weight management program (Brenner FIT Program). Tina, a 14-year-old White female, and her mother participated in the Brenner FIT Program where we successfully integrated MI into her obesity treatment. Further work is needed in the application of MI to diverse care teams to determine frequency of training required for effective use of MI in obesity treatment, its limitations, and its feasibility in community-based programs.

Comprehensiveness and continuity of care and the inseparability of mental and behavioral health from the patient-centered medical home.

Abstract: Comprehensiveness and continuity of care are key elements of primary care system redesign. Comprehensiveness encompasses evaluating the whole person and dealing with the full range of physical, mental, and behavioral healthcare issues; and continuity is based on building healing relationships over time. This article suggests that a focus on comprehensiveness and continuity implies that responding to mental health, behavioral health, and substance use must be core elements of the patient-centered medical home. A list of necessary next steps toward achieving comprehensive and integrated care is recommended.

"It has been a good growing experience for me": growth experiences among African American youth coping with parental cancer.

Abstract: This qualitative focus group study describes posttraumatic growth experiences of African American adolescents currently coping with parental breast cancer. Twelve adolescents participated in three focus groups assessing their experiences with parental cancer. Spontaneous accounts of posttraumatic growth were reported by all participants. A content analysis revealed reports in four of the five domains of posttraumatic growth identified by Tedeschi and Calhoun (1996) which included: greater appreciation for life, enhanced interpersonal relationships, increased sense of personal strengths, and changed priorities. An additional domain, change in health behaviors and attitudes, also emerged. These findings add important knowledge to the developing field of research in posttraumatic growth in populations where available research is scarce, especially among adolescents and racial minorities.

St. Louis Initiative for Integrated Care Excellence (SLI(2)CE): integrated-collaborative care on a large scale model

Abstract: The primary care health setting is in crisis. Increasing demand for services, with dwindling numbers of providers, has resulted in decreased access and decreased satisfaction for both patients and providers. Moreover, the overwhelming majority of primary care visits are for behavioral and mental health concerns rather than issues of a purely medical etiology. Integrated-collaborative models of health care delivery offer possible solutions to this crisis. The purpose of this article is to review the existing data available after 2 years of the St. Louis Initiative for Integrated Care Excellence; an example of integrated-collaborative care on a large scale model within a regional Veterans Affairs Health Care System. There is clear evidence that the SLI(2)CE initiative rather dramatically increased access to health care, and modified primary care practitioners' willingness to address mental health issues within the primary care setting. In addition, data suggests strong fidelity to a model of integrated-collaborative care which has been successful in the past. Integrated-collaborative care offers unique advantages to the traditional view and practice of medical care. Through careful implementation and practice, success is possible on a large scale model.

Using a multi-level approach to implement a primary care mental health (PCMH) program

Abstract: Successfully spreading innovation across large health care systems is a complex process requiring participation of stakeholders from a broad spectrum of professional backgrounds, skill sets, and organizational levels. We describe a process for engaging and activating stakeholders across individual, team, organization, and system levels to implement primary care-mental health integrated care programs in one regional Veterans Affairs health care network. Key stakeholders and researchers collaborated to propose and implement the program. Preliminary findings indicate that the program may reduce referrals to specialty mental health care.

Older couples' management of multiple-chronic illnesses: Individual and shared perceptions and coping in Type 2 diabetes and osteoarthritis.

Abstract: Using data from interviews with 28 older couples in which 1 spouse was diagnosed with diabetes and osteoarthritis, we examined illness perceptions and coping activities as they relate to illness management and relationship resilience. Qualitative analysis of interview transcripts revealed categories of data related to perceptions, coping, and cross category comparisons. Findings suggest that couples experience both negative and positive perceptions of their illnesses, indicating a balance between the reality of their illness challenges and an optimistic outlook of the future. Coping activities included a variety of tasks and were performed by individuals, by both spouses in a shared effort, and by individuals and shared couple efforts. Findings highlight the complexity of individual and shared couple illness perception and couple efforts in managing multiple-chronic illnesses.

Creating collaborative learning environments for transforming primary care practices now.

Abstract: The renewal of primary care waits just ahead. The patient-centered medical home (PCMH) movement and a refreshing breeze of collaboration signal its arrival with demonstration projects and pilots appearing across the country. An early message from this work suggests that the development of collaborative, cross-disciplinary teams may be essential for the success of the PCMH. Our focus in this article is on training existing health care professionals toward being thriving members of this transformed clinical care team in a relationship-centered PCMH. Our description of the optimal conditions for collaborative training begins with delineating three types of teams and how they relate to levels of collaboration. We then describe how to create a supportive, safe learning environment for this type of training, using a different model of professional socialization, and tools for building culture. Critical skills related to practice development and the cross-disciplinary collaborative processes are also included. Despite significant obstacles in readying current clinicians to be members of thriving collaborative teams, a few next steps toward implementing collaborative training programs for existing professionals are possible using competency-based and adult learning approaches. Grasping the long awaited arrival of collaborative primary health care will also require delivery system and payment reform. Until that happens, there is an abundance of work to be done envisioning new collaborative training programs and initiating a nation-wide effort to motivate and reeducate our colleagues.

Social support mediates the relations between role strains and marital satisfaction in husbands of patients with fibromyalgia syndrome.

Abstract: Husbands of patients with fibromyalgia syndrome (HFMS) report poorer physical and mental health than husbands of women without illness, as well as role strains because of their wives' condition. There are no published reports regarding the impact of fibromyalgia on their marital relationship. In the present study, we used Lazarus and Folkman's (1984) model of stress and coping as a framework to examine marital satisfaction among HFMS. We hypothesized that role strains would be related to marital satisfaction, mediated or moderated by social support and problem and emotion focused coping. HFMS (n=135) and husbands of healthy women (n=153) completed the Locke Wallace Marital Adjustment Test, the Interpersonal Support Evaluation List, and the Ways of Coping Questionnaire. Only HFMS completed the Psychological Adjustment to Illness Scale-Spouse Version. HFMS reported lower marital satisfaction than comparison husbands. Among HFMS, sexual and domestic roles strains and social support were related to marital satisfaction. Social support alone mediated the relationship between role strain and marital satisfaction, and no variable moderated the relationship. These findings support prior research that shows that these husbands are significantly impacted by their wives' condition, and suggest the need to focus more attention on this population, possibly targeting social support for interventions.

Relinquishing frozen embryos for conception by infertile couples

Abstract: This qualitative study sought to provide an in-depth understanding of the experiences of couples who have relinquished their stored frozen embryos to one or more infertile couples. All couples were recruited through a U.S. based not-for-profit, prolife, Christian “embryo adoption” agency. In-depth semistructured interviews were undertaken via e-mail. Implications for practice strategies, including effective ways for educating couples with surplus frozen embryos are offered.

Effects of team care of frequent attenders on patients and physicians.

Abstract: Frequent clinic attenders consume a large portion of health care resources while feeling underserved. At the same time, physicians are frustrated trying to adequately care for these patients. Previous trials of team care in primary care have rarely included control groups. Adults with eight or more clinic visits in the past year were nonrandomly assigned to usual care or team care. For the latter group, a Care Team met to review each case and create a care plan. Changes in patient health care use, well-being, and satisfaction from baseline to 6 months were compared between team care and usual care patients. In addition, Care Team members' perceptions of team care were assessed by quantitative and qualitative methods. Study patients were medically complex. Self-reported overall well-being and overall care satisfaction improved in the 12-patient team care group, but remained unchanged in the 8 patient usual care group. Median 6-month visits fell by 3 visits among team care patients and increased by 1.5 among usual care patients. Most Care Team members rated team care as positive and as improving quality of care. Members were divided on its effect on care efficiency and workload. Team care is feasible within a family medicine residency practice and may improve care.

Therapeutic assessment of families in healthcare settings: A case presentation of the model's application.

Abstract: In this article, we present a case study of a Therapeutic Assessment (TA) with an 11year-old boy who had two unexplained behavioral episodes suggesting neurological impairment, which led to two emergency department visits at a children’s hospital. TA is a semistructured approach that blends the extensive conceptualizing benefits of psychological assessment with the principles and techniques of evidence-based child and family interventions. We use this case to illustrate how TA is an adaptive and flexible approach to child-centered family assessment that can meet the goals of psychologists working in pediatric and general medical hospitals, primary care clinics, family medicine practices, and other health care settings. With the current case, the clinician was able to use the procedures of TA to clarify for the family their son’s unexplained behaviors, while also providing them with a therapeutic experience. In addition to addressing the family’s concerns, the clinician also addressed a number of specific questions provided by the referring neurologist that informed ongoing care of the child. This case illustrates the potential utility and effectiveness of the TA model with children and families referred to a typical psychology service in a health care setting. This case is one of the first applications of the TA model with this population and its success suggests further research in this area is warranted.

Effectiveness of a Psychoeducational Parenting Group on Child, Parent and Family Behavior: A Pilot Study in a Family Practice Clinic with an Underserved Population

Abstract: Over the last several decades the medical and mental health fields have worked to create collaborative relationships in order to provide integrated (mind-body) care for adults (Frank, McDaniel, Bray, & Heldring, 2003; Gatchel & Oordt, 2003; Haas, 2004; McDaniel, Hepworth & Doherty, 1992; Moss, McGrady, Davies & Wickramasekera, 2003). Results have suggested that adult integrated primary care: (1) increases communication between doctor and patient, (2) increases management of behavioral health symptoms, (3) increases management of chronic conditions such as diabetes and asthma, and (4) reduces overall visit frequency (Gallo, et al., 2004; Law & Crane, 2000; Law, Crane & Berge, 2003; Mendenhall & Berge, in press; Moss, et. al., 2003). These promising results have suggested the need to look at providing integrated care for children in primary care, but there has been a lack of research in this area outside of specialty care clinics (Bradley, et. al., 1999; Cunningham, et.al., 2008; Kitchiner & Bundred, 1996). Thus, the main purpose of this paper is to report results of a pilot study testing initial feasibility of a parenting psychoeducational group targeting child behavioral problems within a primary care clinic in order to improve integrated care options for children and their families. Parenting/Relational Issues and Primary Care There is a need for more relational interventions housed within primary care clinics. Research on mental health problems in primary care indicate that over 65% of patients who report mental health problems (e.g. depression, anxiety) to primary care doctors report “relationship problems” as one of the main causes of the mental health problem (Kroenke, & Mangelsdorff; 1989). Based on experiential evidence within the clinic where this study was conducted, MD residents and faculty report that over half of the parents that present for primary care visits identify that one of the main reasons for their visit is “problems with their kids,” or “stress because of their family.” Thus, parenting psychoeducational groups may offer a resource for the primary care doctor, the patient, and the child. Psychoeducational groups are not new to primary care clinics, many chronic health conditions (e.g. diabetes, asthma, chronic pain) are being treated with a combination of individual primary care visits and “group visits” (Gatchel & Oordt, 2003). For instance, in treating diabetes many primary care clinics offer group visits to patients where they learn about basic diabetes education, psychosocial symptoms that may co-occur with diabetes, specific management techniques (e.g. lifestyle changes), and receive social support. Research has identified that these types of groups have been effective in decreasing isolation, increasing management behaviors, and in some cases reducing hemoglobin A1c levels in diabetic patients (Crane & Marshall, 2006; Gatchel & Oordt, 2003; Mendenhall & Berge, in press; Moss, et.al., 2003). Similarly, parenting psychoeducational groups could be utilized to manage chronic relational problems between children and their parents as an outlet for integrated care within primary care clinics. Parent Management Training A wide variety of research studies over more than twenty years have shown that children’s behavior reliably improves as a result of training the parents to behaviorally manage and communicate more effectively with their children. Programs have included therapists with individual couples or single parents, therapists working conjointly with parents and the child, and psychoeducational group training programs (O’Dell, 1985). Moreover, there is an abundant developmental literature defining parental styles and their positive or negative outcomes on children. Each parent management training approach typically has overlapping elements, as well as, specific constructs unique to their individual approach. Reviews of the literature (Hart, Newell, & Olsen, 2003; Ladd & Pettit, 2002) identify three major overlapping dimensions across parent management approaches that link parenting practices to confident and competent children. Earlier studies referred to these dimensions as warmth, expectation, and respect for individuality (Baumrind, 1967, 1971; Damon, 1988); later definitions utilized the terms connection, regulation, and autonomy (Hart et al., 2003). The present study uses a parenting curriculum that focuses on these three dimensions of parenting and calls them Love, Limits and Latitude (LLL). Underserved Populations and Primary Care Because underserved populations are typically difficult to reach and have high drop-out rates in research, they are an important population to learn about (Fiscella & Holt, 2007; Miranda, et.al., 2004; Reschovsky, & O’Malley, 2008). Patients who are mostly minority, with low income and low education levels are commonly found within inner city primary care clinics (Fiscella & Holt, 2007; Miranda, Schoenbaum, Sherbourne, Duan, & Wells, 2004; Reschovsky, & O’Malley, 2008). Providing parenting psychoeducational groups to underserved populations within primary care clinics provides a natural avenue to access and engage a population that is typically hard to reach. Using primary care clinics as a research base may allow for: (a) underserved populations to feel less stigmatized because they are comfortable in the primary care setting, (b) increased convenience for research involvement, (c) potential increase in the adherence to research protocol or reduced drop-out rates. Research Questions In order to establish initial feasibility of a parenting psychoeducational program in an underserved population in Minneapolis, a pilot study was conducted to address three main research questions. These questions were primarily chosen based on the needs of the families in the clinic, which were most commonly communicated as “complaints” relayed to their primary care doctors at medical visits (i.e. family functioning problems, child misbehavior and couple relationships problems). The following research questions were addressed in this study: (a) Does self-reported family functioning increase after participation in the LLL parent psychoeducational group? (b) Does self-reported child misbehavior decrease after participation in the LLL parent psychoeducational group? and (c) Does self-reported couple relationship distress decrease after participation in the LLL parent psychoeducational group?

Building a medical home around the patient: what it means for behavior.

Abstract: A great deal has already been written on "patient-centered health care." This article aims to organize and make readily visible some of that work in context of the "patient-centered medical home" (PCMH). Patient-centered provider and patient behaviors are both required if PCMH is to become a successful innovation in practice. These behaviors are shown together on one page as dimensions of patient centeredness. A medical home that achieves patient-centered results will require different behaviors and attitudes from both patients and providers.

The role of family therapy in mediating adverse effects of excessive and inconsolable neonatal crying on the family system.

Abstract: Prolonged and inconsolable new infant crying is 1 of the most challenging tasks for parental caregivers to ameliorate and manage. As parent(s) attempt to meet the stressors associated with this situation, multiple subsystems within the family may be adversely affected. Lasting interactional difficulties often result, interfering with the healthy development of parent-child and parent-parent dyads. This article examines these risks to the family system, suggests an important role for intervention by family practitioners, and presents recommendations for intervention by clinicians.

A purveyor team's experience: lessons learned from implementing a behavioral health care program in primary care settings.

Abstract: A growing body of literature indicates that evidence-based behavioral health practices and programs are not being implemented into clinical settings effectively. As a result, many adolescents living with a behavioral health problem are not receiving the quality of services they need. This feasibility study addressed this science-to-service gap through the implementation of an evidence-based adolescent behavioral health screening, assessment, and brief intervention protocol in five distinct primary care settings. This case study documents the authors' experiences in utilizing Fixsen, Naoom, Blase, Friedman, and Wallace's (2005) implementation framework to guide their purveyor efforts, and outlines solutions to overcoming the challenges purveyors may face when implementing evidence-based programs into primary care.

Collaborative care needs a more active policy voice.

Abstract: If you are reading this, there is a high likelihood you think collaborative care, or, the integration of mental health and physical health systems, is important to healthcare delivery and healthcare policy. Despite over 30 years of work, broad federal and state policy has been slow to adopt specific integration strategies that allow for more tightly coordinated, comprehensive whole-person care (Butler et al., 2008; Collins, Hewson, Munger, & Wade, 2010; Institute of Medicine, 2001; Institute of Medicine 2006). In the last year, policy shifts have brought integrated or collaborative care into the spotlight, but there is very little history of formal policy discussion in this area to guide progress. If FSH is to impact healthcare policy, enhance the quality of care, and move the healthcare system toward team-based collaborative care, we need more policy statements and discussions grounded in the research. By publishing these types of articles, FSH can help the collaborative care community be more influential in healthcare policy.

A special issue on the patient-centered medical home.

Abstract: This special issue on the Patient-Centered Medical Home (PCMH) reflects its times. At the present time, the PCMH is an aspirational model with a few pilots functioning well around the country. How long the current period of idealism, fueled by the energy of early adopters, the consensus of diverse stakeholders, and the dollars of the Affordable Care Act will continue is anybody's guess. Representing the thinking of some of the best minds in the field, the articles in this issue have an aspirational and idealistic tone as much as a descriptive and analytic one. A year ago the balance would have been tipped more toward idealism and model building and a year from now it would, in all likelihood, tip more toward model description and analysis. The authors in this volume have been personally responsible for helping to move behavioral health to a more central position in the PCMH model.