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Showing papers in "Families, Systems, & Health in 2011"


Journal ArticleDOI
TL;DR: Findings suggest that there may be differences in mothers' and fathers' perceptions and expectations about family functioning and this difference needs to be explored and applied when working with families of children with ASD.
Abstract: The prevalence of Autism Spectrum Disorder (ASD) is 1 in 110 persons in the U.S. Both parents of children with ASD are under stress that may impact their health-related quality of life (HRQL) (physical and mental health). The purpose of the current study was to explore the relationship of parenting stress, support from family functioning and the HRQL (physical and mental health) of both parents. Female (n = 64) and male (n = 64) parents of children with ASD completed Web-based surveys examining parenting stress, family functioning, and physical and mental health. Results of a Wilcoxon signed-ranks test showed that female parent discrepant (D) scores between "what is" and "should be" family functioning were significantly larger than male parents, p = .002. Results of stepwise linear regression for the male-female partners showed that (1) higher female caregiving stress was related to lower female physical health (p < .001), (2) a higher discrepancy score in family functioning predicted lower mental health (p < .001), accounting for 31% of the variance for females and (3) male parent personal and family life stress (p < .001) and family functioning discrepant (D) score (p < .001) predicted poor mental health, with the discrepancy score accounting for 35% of the variance. These findings suggest that there may be differences in mothers' and fathers' perceptions and expectations about family functioning and this difference needs to be explored and applied when working with families of children with ASD.

205 citations


Journal ArticleDOI
TL;DR: This paper is based on an extensive review of the literature focusing on emerging technologies and the experience of the author as a consultant to health care professionals learning about social technologies to define a set of social technologies with potential for developing, sustaining, and strengthening the collaborative health agenda.
Abstract: The exponential growth, variety, and sophistication of the information communication technologies (ICTs) plus their growing accessibility are transforming how clinical practitioners, patients, and their families can work together. Social technologies are the ICTs tools that augment the ability of people to communicate and collaborate despite obstacles of geography and time. There is still little empirical research on the impact of social technologies in the case of collaborative health. Defining a set of social technologies with potential for developing, sustaining, and strengthening the collaborative health agenda should prove useful for practitioners and researchers. This paper is based on an extensive review of the literature focusing on emerging technologies and the experience of the author as a consultant to health care professionals learning about social technologies. A note of caution is required: the phenomenon is complex and hard to describe in writing (a medium very different from the technologies themselves). Hardware and software are in continuous development and the iterative adaptation of the emergent social technologies for new forms of virtual communication.

73 citations


Journal ArticleDOI
TL;DR: This pilot demonstrates the feasibility and potential efficacy of a telephone intervention for Type 2 diabetes patients and their partners and led to refinement and further development of the intervention, which is being assessed in a larger, more comprehensive trial.
Abstract: A pilot study was conducted to assess the feasibility and potential efficacy of a couples focused diabetes intervention in which a collaborative problem-solving approach to diabetes self-care was promoted. Couples (N = 44), in which one partner had Type 2 diabetes and was in poor blood glucose control were randomly assigned to one of three groups: a couples intervention, an individual intervention, or individual diabetes education. The intervention included goal-setting, dietary behavior change, and a focus on emotions. For those in the couples arm, this was done within the framework of promoting collaborative communication between the partners. All intervention contacts were over the telephone to increase reach. Results showed that both the individual and couples interventions yielded meaningful clinical improvements in medical outcomes. Diabetes education also resulted in improved blood glucose control. Despite the small number, mixed-model regression analyses found statistically significant treatment effects for total cholesterol. This pilot demonstrates the feasibility and potential efficacy of a telephone intervention for Type 2 diabetes patients and their partners. Information from implementing this pilot led to refinement and further development of the intervention, which is being assessed in a larger, more comprehensive trial.

60 citations


Journal ArticleDOI
TL;DR: A number of professional areas in which physicians may experience significant feelings of loss or lack of personal control-difficult encounters with patients, dealing with patient nonadherence, end-of-life care, as well as institutional and systemic factors that can result in loss of various forms of autonomy and control over decision-making are explored.
Abstract: Although the quest for active control and mastery can be seen as a central thread that ties together important aspects of human experience, we are frequently confronted with the reality that much of what is encountered in life lies outside our active instrumental control. Control must involve finding healthy and life-affirming ways to exercise personal mastery, and identifying constructive ways to respond to the lack of control that pervades the human condition. In this article we explore a number of professional areas in which physicians may experience significant feelings of loss or lack of personal control-difficult encounters with patients, dealing with patient nonadherence, end-of-life care, confronting the uncertainty and ambiguity that are frequently a part of illness, as well as institutional and systemic factors that can result in loss of various forms of autonomy and control over decision-making. We then consider maladaptive ways in which physicians sometimes attempt to address such losses of control and suggest that personal stress and burnout and difficulty developing effective therapeutic relationships with patients may be the consequence, in part, of these efforts. Finally, we discuss an empirically derived, multidimensional theoretical model for better understanding control dynamics, and identifying more optimal strategies physicians can employ in their efforts to gain and regain a sense of control in caring for patients.

48 citations


Journal ArticleDOI
Karen Fergus1
TL;DR: It is concluded that the intersubjective embodiment displayed by couples in this study was instrumental to the "repair" of the communal body ruptured by prostate cancer.
Abstract: Intimate partners' ability to adopt a "we" outlook in relation to cancer has consistently been associated with optimal adaptation for couples. This investigation adds to the growing body of literature on dyadic coping and resiliency in couples through an in-depth examination of five well-adjusted couples' experiences with prostate cancer. Of specific interest were (1) how the experience of prostate cancer affected the couple's unique intersubjective identity, and how in turn (2) the couple's identity and relationship culture influenced their adjustment to cancer. An ethnographic mode of inquiry was adopted. Marital partners were interviewed together on two separate occasions with the intention of having them deepen their conjoint reflexive processing of their relationship. During the interviews, couples were asked to reflect upon and articulate their sense of themselves as a couple, their experience of "we-ness" and shared identity, and the interaction between the illness and we-ness. Interviews were transcribed verbatim and analyzed using the grounded theory method. The grounded theory analysis yielded three main themes portraying the couples' experience of prostate cancer: (1) riding the vortex, (2) holding the communal body intact, and (3) invincibility and its underbelly. A more broad understanding to arise from this investigation was the notion of a "communal body" and that couples participated in a shared corporeality, to which each partner's identity and sense of self was intricately tied. It is concluded that the intersubjective embodiment displayed by couples in this study was instrumental to the "repair" of the communal body ruptured by prostate cancer.

41 citations


Journal ArticleDOI
TL;DR: It is argued that considering culture, or the values, beliefs, and customs of the family, including their choice of language, is necessary to understand fully a family's response to cancer.
Abstract: Cancer is a family experience, and family members often have as much, or more, difficulty in coping with cancer as does the person diagnosed with cancer. Using both family systems and sociocultural frameworks, we call for a new model of health promotion and psychosocial intervention that builds on the current understanding that family members, as well as the individuals diagnosed with cancer, are themselves survivors of cancer. We argue that considering culture, or the values, beliefs, and customs of the family, including their choice of language, is necessary to understand fully a family's response to cancer. Likewise, acknowledging social class is necessary to understand how access to, and understanding of, otherwise available interventions for families facing cancer can be limited. Components of the model as conceptualized are discussed and provide guidance for psychosocial cancer health disparities research and the development of family-focused, strength-based, interventions.

39 citations


Journal ArticleDOI
TL;DR: PTG was positively associated with trait anxiety, PTSS, and the use of active, problem-focused coping strategies and the relationship between PTSS and PTG is moderated by whether the relative's current illness status is resolved versus not resolved.
Abstract: Posttraumatic growth (PTG) involves personal psychological growth in response to a traumatic or very stressful event. Using theoretical guidance from Tedeschi and Calhoun's cognitive model, this study evaluated the relationship between specific individual, distress, and stress-processing factors and PTG among young adults who experienced an illness-related trauma earlier in life through a relative's serious illness. Sixty individuals with a relative with a serious illness completed measures of PTG, posttraumatic stress symptoms (PTSS), anxiety, and coping. PTG was positively associated with trait anxiety, PTSS, and the use of active, problem-focused coping strategies. Factors associated with PTG development in individuals who have a relative with a chronic illness are similar to that of individuals who had a serious illness themselves. The relationship between PTSS and PTG is moderated by whether the relative's current illness status is resolved versus not resolved. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

39 citations


Journal ArticleDOI
TL;DR: Youth who reported more positive qualities, as measured by the YSR-PQ subscale, had better disease management and metabolic control through the association with more family cohesion, but the current results did not support an alternative hypothesis that cohesive families display better diabetes management mediated by higher YSR -PQ scores.
Abstract: We examined the association of youths' positive qualities, family cohesion, disease management, and metabolic control in Type 1 diabetes. Two-hundred fifty-seven youth-parent dyads completed the Family Cohesion subscale of the Family Environment Scale, the Diabetes Behavior Rating Scale, 24-hour diabetes interview, and youth completed the Positive Qualities subscale of the Youth Self Report (YSR-PQ). Structural equation modeling demonstrated that YSR-PQ scores were associated with metabolic control mediated by associations with more family cohesion and better disease management. That is, youth with higher YSR-PQ scores had more cohesive families, better disease management, and, indirectly, better metabolic control. Family cohesion was indirectly associated with better metabolic control mediated by its association with better disease management, but not mediated by its association with YSR-PQ scores. Youth who reported more positive qualities, as measured by the YSR-PQ subscale, had better disease management and metabolic control through the association with more family cohesion. However, the current results did not support an alternative hypothesis that cohesive families display better diabetes management mediated by higher YSR-PQ scores.

35 citations


Journal ArticleDOI
TL;DR: Identifying sociodemographic and medical correlates of both caregiver- and patient-reported general family functioning and determining the unique contributions of these family functioning indices to perceived posttransplant adherence barriers would likely promote more optimal health outcomes in the pediatric kidney transplant population.
Abstract: The alarming rates of medication nonadherence and its detrimental effect on long-term graft survival in pediatric kidney transplantation has called attention to identifying modifiable factors that promote better adherence and subsequent transplant outcomes. In a sample of 45 adolescent kidney transplant recipients (14.7 ± 3.3 years, 77.8% Caucasian, 39.5% female) and their primary caregivers, study aims included: 1) identifying sociodemographic and medical correlates of both caregiver- and patient-reported general family functioning (i.e., efficacy, flexibility, and communication) and 2) determining the unique contributions of these family functioning indices to perceived posttransplant adherence barriers. During a routine clinic visit, caregivers completed a sociodemographic form and questionnaire on general family functioning. Both caregivers and the adolescents completed a measure on perceived medication adherence barriers. Data identified household income and family structure as persistent correlates of family functioning. Familial efficacy and flexibility contributed significant variance to perceived adherence barriers. Family-based interventions enhancing modifiable family factors, such as flexibility and efficacy, in overcoming medication adherence barriers would likely promote more optimal health outcomes in the pediatric kidney transplant population.

27 citations


Journal ArticleDOI
TL;DR: Data indicate that caregiver adjustment in these situations is influenced by cognitive-behavioral characteristics that could be addressed in educational and therapeutic programs provided in the clinic and in the community.
Abstract: DAlthough much is known about the risks tohealth and well-being that occur amongfamily caregivers of children with disabil-ity, little is known about the unique groupof caregivers of children with severe neuro-disabilities who require varying degrees ofrespiratory care including ventilator sup-port. This present study examined the psy-chological adjustment of caregivers in thesesituations, and tested the prediction thatcaregiver coping and problem-solving styleswould be predictive of their physical andemotional health. Hierarchical regressionanalyses revealed that demographic charac-teristics and the severity of pulmonary condi-tion were unrelated to caregiver adjustment.A coping style characterized by developingrelationships, pursuing activities that pro-mote self-worth and individuality, and alower negative orientation toward solvingproblemsweresigniÞcantlypredictiveofcare-giver distress. These data indicate that care-giver adjustment in these situations is insu-enced by cognitiveÐbehavioral characteristicsthat could be addressed in educational andtherapeutic programs provided in the clinicand in the community.Keywords: children, neurodisabilities, fam-ily caregivers, chronic respiratory manage-ment, depression

25 citations


Journal ArticleDOI
TL;DR: Through a qualitative content analysis, three main themes emerged that describe the essence of the practice of medical family therapy: The patient's multisystemic experience of disease, treatment is about caring, not just caregiving, and elevating the patient as collaborator in the care team.
Abstract: In an effort to identify the essential ingredients of medical family therapy, a content analysis of 15 peer-reviewed case studies in medical family therapy was conducted. The case studies were published from 1996 to 2007 in Families, Systems, & Health. Through a qualitative content analysis, three main themes emerged that describe the essence of the practice of medical family therapy: (1) The patient's multisystemic experience of disease, (2) treatment is about caring, not just caregiving, and (3) elevating the patient as collaborator in the care team.

Journal ArticleDOI
TL;DR: The role of the behavioral health consultant is described, including representative services and development and implementation of a clinic-wide depression protocol and barriers to integration are provided.
Abstract: In the past few decades, there has been a move toward integrating behavioral health and medical services. This can be particularly beneficial for rural residents, as integration can increase access to mental healthcare in areas where there are shortages of mental health providers. Southern Appalachia is characterized by isolated areas that have shortages of both mental health and medical providers. This article discusses the experiences of a clinical psychology doctoral student integrating behavioral health services in a primary care clinic within rural Southern Appalachia. The role of the behavioral health consultant is described, including representative services and development and implementation of a clinic-wide depression protocol. Additionally, barriers to integration and recommendations for future training and practice are provided.

Journal ArticleDOI
TL;DR: The difficulties in family adaptation when the family is not able to assign a clear meaning to a chronic symptom posttreatment are described and family stress theory is built upon by highlighting interrelationships among communication patterns and role shifts in the family system.
Abstract: With improvements in both early detection and treatments for breast cancer, the number of survivors has increased dramatically in recent decades. One of the most common lingering symptoms posttreatment for cancer survivors is chronic fatigue. Based on family stress theory and Rolland's typology of illness, this qualitative study extends our understanding of the impact of persistent posttreatment fatigue on families and how breast cancer survivors manage the family issues that arise because of this chronic stressor. Participants included 35 female survivors of breast cancer (mean age = 54 years) who experienced fatigue after the completion of active cancer treatment, with the exception of long-term hormonal therapy. Data were generated from (a) observations of group sessions from a randomized controlled fatigue intervention designed to reduce fatigue in breast cancer survivors, (b) individual in-depth interviews, and (c) family sessions. Qualitative analysis revealed two broad themes that illustrate how the survivors manage the impact of fatigue on their families: Interpreting the meaning of the fatigue and Dealing with the inability to perform family roles. Study findings describe the difficulties in family adaptation when the family is not able to assign a clear meaning to a chronic symptom posttreatment and build upon family stress theory by highlighting interrelationships among communication patterns and role shifts in the family system.

Journal ArticleDOI
TL;DR: The Connecticut Behavioral Health Partnership has forged relationships between primary care and behavioral health providers through its enhanced care clinic (ECC) initiative, which focuses on improved access to behavioral health services and coordination of care for children insured by Medicaid.
Abstract: As many as 15 million children and adolescents in the United States are in need of behavioral health services, and it is often the pediatric primary care system that is their first contact with formal assessment and intervention services. However, pediatric primary care providers (PPCPs) face challenges to assessing and managing children with behavioral health concerns, including lack of time, lack of training, and lack of behavioral health specialists to whom they can refer. The Connecticut Behavioral Health Partnership has forged relationships between primary care and behavioral health providers through its enhanced care clinic (ECC) initiative, which focuses on improved access to behavioral health services and coordination of care for children insured by Medicaid. We report on interviews with 24 PPCPs and 8 staff/administrators from 12 pediatric practices throughout the state about their experiences with the ECCs. The majority of participants expressed satisfaction with the behavioral health partnerships and, based on their experience, would join the partnership again.

Journal ArticleDOI
TL;DR: Although children and parents report some similarities in their perceptions of child coping, parents do not recognize all the coping strategies that children report, suggesting potential for improvement in parent-child communication concerning coping techniques.
Abstract: Pediatric physical injury is a very common, potentially traumatic medical event that many families face each year. The role that child or parent coping behavior plays in emotional recovery from injury is not well understood. This study described coping used by children and coping assistance implemented by parents in the early aftermath of a child's injury. Ten child-parent dyads participated in individual semistructured interviews that were audiorecorded, transcribed, and coded using hierarchical coding schemes. Study findings highlight reliance on a broad range of coping strategies. Although children and parents report some similarities in their perceptions of child coping, parents do not recognize all the coping strategies that children report. This suggests potential for improvement in parent-child communication concerning coping techniques. Parents report a limited number of coping assistance strategies, indicating a niche for preventive programs. Further research should examine coping during the peritrauma period as it relates to physical and emotional outcomes to inform secondary prevention programs. (PsycINFO Database Record (c) 2011 APA, all rights reserved). Language: en

Journal ArticleDOI
TL;DR: Patients can become more adept at describing their health concerns, organizing their needs and questions, and being proactive, which can have a positive effect on the quality of the doctor-patient communication during outpatient office visits.
Abstract: In research on doctor-patient communication, the patient role in the communication process has received little attention. The dynamic interactions of shared decision making and partnership styles which involve active patient communication are becoming a growing area of focus in doctor-patient communication. However, patients rarely know what makes "good communication" with medical providers and even fewer have received coaching in this type of communication. In this study, 180 patients were randomly assigned to either an intervention group using a written communication tool to facilitate doctor-patient communication or to standard care. The goal of this intervention was to assist patients in becoming more effective communicators with their physicians. The physicians and patients both rated the quality of the communication after the office visit based on the patients' knowledge of their health concerns, organizational skills and questions, and attitudes of ownership and partnership. The results supported that patients in the intervention group had significantly better communication with their doctors than patients in the standard care condition. Physicians also rated patients who were in the intervention group as having better overall communication and organizational skills, and a more positive attitude during the office visit. This study supports that helping patients structure their communication using a written format can facilitate doctor-patient communication. Patients can become more adept at describing their health concerns, organizing their needs and questions, and being proactive, which can have a positive effect on the quality of the doctor-patient communication during outpatient office visits. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Journal ArticleDOI
TL;DR: The results suggest that BFI might be a cost-efficient way of meeting the needs of somatoform patients, and replication in other cultural contexts and dismantling studies to identify the effective ingredients of BFI are recommended.
Abstract: We sought to determine the cost-efficiency of a brief family intervention program for patients with somatoform disorder. Two hundred fifty-six somatoform patients from 7 centers of primary care in Chile were randomly assigned to either brief family intervention (BFI) or treatment as usual. The experimental group presented a significant cost reduction (p = .001) 6 months and 12 months after the intervention, with lower costs than the control group on all measured variables and no decrease in patient satisfaction. Our results suggest that BFI might be a cost-efficient way of meeting the needs of somatoform patients. Replications in other cultural contexts and dismantling studies to identify the effective ingredients of BFI are recommended.

Journal ArticleDOI
TL;DR: The Mano a Mano's CBPR approach and sequence to answer this call, the culmination of its efforts to date, lessons learned, and next steps in the formal evaluation and extension of this collaborative work are outlined.
Abstract: Mano a Mano (Spanish translation: "Hand to Hand") is a nonprofit organization that is working in partnership with underserved Bolivian communities to cocreate medical infrastructures and to improve health. Using community-based participatory research (CBPR) methods, Mano a Mano engages local government and community leaders, health care providers, educators, and ordinary citizens in a manner that taps local strengths and resources to allow all participants to work together to realize this mission. After describing Bolivia's call for improved access to high quality care in its poor and underserved rural areas, we outline the Mano a Mano's CBPR approach and sequence to answer this call, the culmination of its efforts to date (including the establishment of 119 health care facilities), lessons learned, and next steps in the formal evaluation and extension of this collaborative work.

Journal ArticleDOI
TL;DR: A measure of health-related beliefs for parents of AYA cancer survivors was developed and beliefs identified are consistent with clinical observations of families of young adult survivors and provide indications for the importance of ongoing attention to the families of childhood cancer survivors.
Abstract: Childhood cancer has long-term implications for survivors and their family members. While the impact of cancer on the family continues into adulthood, little research exists on family related issues during this important developmental period. In order to advance our understanding of families of adolescent and young adult (AYA) childhood cancer survivors, a measure of health-related beliefs for parents of AYA cancer survivors was developed. Exploratory factor analysis based on the mothers' data was used to identify four factors among 23 items: Social Competence, Satisfaction with Healthcare, Health Perceptions, and Health Apprehension. The scales are associated with psychological distress, quality of life, and posttraumatic stress symptoms but unrelated to age of the child at diagnosis and cancer treatment intensity. The beliefs identified in this study are consistent with clinical observations of families of young adult survivors and provide indications for the importance of ongoing attention to the families of childhood cancer survivors.

Journal ArticleDOI
TL;DR: Relationship quality accounted for 11% of the variance in secondary traumatic stress, in addition to the 19% already accounted for by patients' posttraumatic stress, and exhibited buffering effects benefiting couples with higher quality relationships.
Abstract: A considerable amount of research has investigated symptoms of posttraumatic stress in cancer patients while the occurrence and correlates of secondary traumatic stress on patients' intimate partners has yet to be explored. This study examined the prevalence of secondary traumatic stress symptoms (Modified Secondary Trauma Questionnaire) in partners of cancer patients and evaluated the association of these symptoms with patients' posttraumatic stress symptoms (Impact of Event Scale-Revised). The study also investigated the moderation effect of relationship quality (Marital Satisfaction Inventory-Revised) on the association between patients' and partners' posttraumatic and secondary traumatic stress respectively. A heterogeneous sample of 90 patient-partner dyads was recruited through a provincial cancer agency. Multiple symptoms of secondary traumatic stress were reported by 23% of partners. These symptoms were experienced at a clinically significant level by 10% of all participating partners. Although patients' and partners' traumatic stress symptoms were correlated (r = .44, p < .001), only one dyad consisted of both a patient and a partner scoring clinically significant levels of traumatic stress symptoms. Therefore, of the 90 dyads in the study, 18% included at least one partner reporting clinically significant levels of traumatic stress. Relationship quality accounted for 11% of the variance in secondary traumatic stress, in addition to the 19% already accounted for by patients' posttraumatic stress. Relationship quality also exhibited buffering effects benefiting couples with higher quality relationships. Implications of results for future research and holistic health care models are discussed.

Journal ArticleDOI
TL;DR: Caring for patients with mental health comorbidities requires time not now affordable in the primary care setting, and demands a new payment policy to promote team-based, integrated care for mental and physical illness in a patient-centered medical home.
Abstract: P care plays a critical role in treating mental health conditions, but caring for patients with comorbid mental health and medical conditions increases visit length. Lack of appropriate reimbursement mechanisms and competing priorities make it difficult to integrate mental health into primary care. Caring for patients with mental health comorbidities requires time not now affordable in the primary care setting, and demands a new payment policy to promote team-based, integrated care for mental and physical illness in a patient-centered medical home. Primary care delivers more mental health care than any other health care setting (Regier, Narrow, Rac, Manderscheid, Locke, & Goodwin, 1993). Mental health and physical health conditions are inseparable, yet our health care system treats them as if they should be treated separately (deGruy, 1996; Regier et al., 1993). The existence of depression or another mental health condition with a physical health condition in patients increases the complexity of treatment and costs, often with poor outcomes (Ani, Bazargan, Hindman, Bell, Rodriguez, & Baker, 2009; Lurie, Manheim, & Dunlop, 2009; Moussavi, Chatterji, Verdes, Tandon, Patel, & Ustun, 2007). The current health care business model rewards volume of services. The fee-forservice payment system incentivizes physicians to increase numbers of services as quickly as possible, inherently decreasing incentives for treating complex, time consuming patients. Median primary care visits are 15.7 min covering a median of six topics (Tai-Seale, McGuire, & Zhang, 2007). In primary care, typical mental health discussions last 2 min (Tai-Seale, McGuire, Colenda, Rosen, & Cook, 2007; Fig. 1). According to the National Ambulatory Medical Care Survey (NAMCS), primary care providers spend significantly more time with patients who have recognized Benjamin F. Miller, PsyD, Department of Family Medicine, University of Colorado Denver, School of Medicine; Bridget Teevan, MS, Robert L. Phillips, Jr., MD, MSPH, Stephen M. Petterson, PhD, and Andrew W. Bazemore, MD, MPH, The Robert Graham Center. Correspondence concerning this article should be addressed to Benjamin F. Miller, PsyD, Department of Family Medicine, University of Colorado Denver, School of Medicine, Academic Office 1, Mail Stop F496, 12631 East 17th Avenue, Aurora, CO 80045. E-mail: Benjamin.miller@ucdenver.edu Families, Systems, & Health © 2011 American Psychological Association 2011, Vol. 29, No. 2, 144–145 1091-7527/11/$12.00 DOI: 10.1037/a0023993

Journal ArticleDOI
TL;DR: Recognized challenges included the need to improve family and community involvement, develop ongoing cultural sensitivity training for staff at the center, and hire more providers who match the ethnic and racial makeup of the center's clientele.
Abstract: This qualitative focus group (FG) study describes an interdisciplinary health care team's collaboration while serving an underprivileged patient population. Collaboration was explored with diverse personnel from support staff to upper administration at a nurse-managed community-based health center in the northeastern region of the United States. Biopsychosocial theory and a feminist ecological framework were used to explore how multiple contextual variables of patients and their providers influence the collaborative process of 39 staff. Content analysis revealed facilitators and barriers to collaboration. Providers' perceptions of care revealed a patient-centered approach with serendipitous family and community involvement. Recognized challenges included the need to improve family and community involvement, develop ongoing cultural sensitivity training for staff at the center, and hire more providers who match the ethnic and racial makeup of the center's clientele.

Journal ArticleDOI
TL;DR: The purpose of this quality improvement project is to evaluate parental perceptions of a support and education day called the "Brachial Plexus Family Day."
Abstract: Children with obstetrical brachial plexus palsy may have chronic physical impairment in their affected upper extremity. Affected children and their families may benefit from psychosocial interventions including therapeutic relationships with health professionals, meeting other families living with obstetrical brachial plexus palsy, support groups, and social work. One method of addressing psychosocial needs is through a support and education day. The purpose of this quality improvement project is to evaluate parental perceptions of a support and education day called the "Brachial Plexus Family Day." Families of children with obstetrical brachial plexus palsy who attended the Brachial Plexus Family Day completed a questionnaire to evaluate the different programs offered during the day. The families also ranked the importance of different psychosocial supports offered in the clinic. Sixty-three out of 69 families completed the questionnaire. Each program of the Brachial Plexus Family Day was rated as good or excellent by the respondents. Ninety-seven percent of respondents rated meeting other families and children with obstetrical brachial plexus palsy as helpful supports. Attending a Brachial Plexus Family day event (86%), followed by connecting with a doctor (60%), and physical or occupational therapist (59%) were the highest ranked supports reported by the families. The parents and caregivers that attended the Brachial Plexus Family Day rated the program highly. This group also valued the opportunity to connect with other families and children affected with the same condition.

Journal ArticleDOI
TL;DR: It is concluded that teaching the relationship skills of effective team membership is feasible, but hard and has transformative implications for patient relationships, residency training and the practice of family medicine.
Abstract: Primary care reform proponents advocate for patient-centered medical homes built on interdisciplinary teamwork. Recent efforts document the difficulty achieving reform, which requires personal transformation by doctors. Currently no widely accepted curriculum to teach team membership in Family Medicine residencies exists. Organizational Development (OD) has 40 years of experience assessing and teaching the skills underlying teamwork. We present a curriculum that adapts OD insights to articulate a framework describing effective teamwork; define and teach specific team membership skills; reframe residents' perception of medicine to make relationships relevant; and transform training experiences to provide practice in interdisciplinary teamwork. Curriculum details include a rotation to introduce the new framework, six workshops, experiential learning in the practice, and coaching as a teaching method. We review program evaluations. We discuss challenges, including institutional resources and support, incorporation of a new language and culture into residency training, recruitment "for fit," and faculty/staff development. We conclude that teaching the relationship skills of effective team membership is feasible, but hard. Succeeding has transformative implications for patient relationships, residency training and the practice of family medicine.