Showing papers in "Families, Systems, & Health in 2012"

Longitudinal outcomes after brief behavioral health intervention in an integrated primary care clinic.

Abstract: The primary aim of the current study was to obtain information about the longitudinal clinical functioning of primary care patients who had received care from behavioral health consultants (BHCs) integrated into a large family medicine clinic. Global mental health functioning was measured with the 20-item self-report Behavioral Health Measure (BHM), which was completed by patients at all appointments with the BHC. The BHM was then mailed to 664 patients 1.5 to 3 years after receipt of intervention from BHCs in primary care, of which 70 (10.5%) were completed and returned (62.9% female; mean age 43.1 ± 12.7 years; 48.6% Caucasian, 12.9% African American, 21.4% Hispanic/Latino, 2.9% Asian/Pacific Islander, 10.0% Other, 4.3% no response). Mixed effects modeling revealed that patients improved from their first to last BHC appointment, with gains being maintained an average of 2 years after intervention. Patterns of results remained significant even when accounting for the receipt of additional mental health treatment subsequent to BHC intervention. Findings suggest that clinical gains achieved by this subset of primary care patients that were associated with brief BHC intervention were maintained approximately 2 years after the final appointment.

Paternal involvement in pediatric Type 1 diabetes: fathers' and mothers' psychological functioning and disease management.

Abstract: Psychological functioning in fathers of children with Type 1 diabetes has received relatively little attention compared to mothers. This study examined fathers' perceived involvement in their children's diabetes care as it related to mothers' and fathers' pediatric parenting stress, depression, anxiety, marital satisfaction, and sleep, and to their children's diabetes regimen adherence and glycemic control. Eighty-two mothers and 43 fathers completed questionnaires. Multivariate linear regressions were conducted separately for mothers and fathers to determine the relationships between the perceived amount and the perceived helpfulness of father involvement in child diabetes care on parental psychosocial functioning and child diabetes control. Maternal perceptions of father helpfulness and amount of involvement in illness care were related to improved marital satisfaction and fewer depressive symptoms in mothers. In fathers, perception of their own amount of involvement was related to increased pediatric parenting stress and anxiety. Better child regimen adherence was associated with maternal perceptions of father helpfulness but not the amount of their involvement, while paternal perceptions of their own helpfulness were related to poorer glycemic control. These findings suggest that fathers and mothers may react differently to their roles in childhood illness and that perceptions of their involvement may be differently associated with children's glycemic control and regimen adherence.

Patients' and partners' perspectives of chronic illness and its management.

Abstract: This study is framed in theories of illness uncertainty (Babrow, A. S., 2007, Problematic integration theory. In B. B. Whaley & W. Samter (Eds.), Explaining communication: Contemporary theories and exemplars (pp. 181-200). Mahwah, NJ: Erlbaum; Babrow & Matthias, 2009; Brashers, D. E., 2007, A theory of communication and uncertainty management. In B. B. Whaley & W. Samter (Eds.), Explaining communication: Contemporary theories and exemplars (pp. 201-218). Mahwah, NJ: Erlbaum; Hogan, T. P., & Brashers, D. E. (2009). The theory of communication and uncertainty management: Implications for the wider realm of information behavior. In T. D. Afifi & W. A. Afifi (Eds.), Uncertainty and information regulation in interpersonal contexts: Theories and applications, (pp. 45-66). New York, NY: Routledge; Mishel, M. H. (1999). Uncertainty in chronic illness. Annual Review of Nursing Research, 17, 269-294; Mishel, M. H., & Clayton, M. F., 2003, Theories of uncertainty. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for nursing (pp. 25-48). New York, NY: Springer) and health information management (Afifi, W. A., & Weiner, J. L., 2004, Toward a theory of motivated information management. Communication Theory, 14, 167-190. doi:10.1111/j.1468-2885.2004.tb00310.x; Greene, K., 2009, An integrated model of health disclosure decision-making. In T. D. Afifi & W. A. Afifi (Eds.), Uncertainty and information regulation in interpersonal contexts: Theories and applications (pp. 226-253). New York, NY: Routledge) and examines how couples experience uncertainty and interference related to one partner's chronic health condition. Specifically, a model is hypothesized in which illness uncertainty (i.e., stigma, prognosis, and symptom) and illness interference predict communication efficacy and health condition management. Participants include 308 dyads in which one partner has a chronic health condition. Data were analyzed using structural equation modeling. Results indicate that there are significant differences in (a) how patients and partners experience illness uncertainty and illness interference and (b) how appraisals of illness uncertainty and illness interference influence communication efficacy and health condition management. We discuss the findings and implications of the study.

Integrating behavioral health services into a university health center: patient and provider satisfaction.

Abstract: The goals of this study were to (a) describe an Integrated Behavioral Health Care (IBHC) program within a university health center and (b) assess provider and patient acceptability and satisfaction with the IBHC program, including behavioral health screening and clinical services of integrated behavioral health providers (BHPs). Fifteen providers (nine primary care providers and six nurses) and 79 patients (75% female, 65% Caucasian) completed program ratings in 2010. Providers completed an anonymous web-based questionnaire that assessed satisfaction with and acceptability of behavioral health screening and the IBHC program featuring integrated BHPs. Patients completed an anonymous web-based questionnaire that assessed program satisfaction and comfort with BHPs. Providers reported that behavioral health screening stimulated new conversations about behavioral health concerns, the BHPs provided clinically useful services, and patients benefited from the IBHC program. Patients reported satisfaction with behavioral health services and reported a willingness to meet again with BHPs. Providers and patients found the IBHC program beneficial to clinical care. Use of integrated BHPs can help university health centers support regular screening for mental and behavioral health issues. Care integration increases access to needed mental health treatment.

Rural Experiences With Mental Illness: Through the Eyes of Patients and Their Families

Abstract: People living in rural areas are often faced with multiple, complex, and seemingly insurmountable barriers to receiving appropriate treatment for mental health problems. Some of the barriers identified in the research literature include inaccessibility to mental health providers, stigma, and limited resources in the community. Despite existing data regarding rural patients and their families, little is known about their lived, personal experiences. For this reason, the purpose of this study was to determine the experience of patients and family members who are dealing with mental illness in rural communities. Based on this qualitative analysis of patient and family members' experiences in rural areas, issues surrounding mental health and treatment are accompanied by significant stigma, often left unresolved, and exacerbated by practical challenges which hinder access to proper mental health resources, frequently leaving rural residents to cope with inadequate solutions or seek their own, alternative solutions.

A collaborative care telemedicine intervention to overcome treatment barriers for Latina women with depression during the perinatal period.

Abstract: Maternal depression is highly prevalent (10 to 20%) during the perinatal period with rates as high as 35 to 40% for Latinas. However, few Latinas are either identified or treated during the perinatal period. To address these disparities, the Perinatal Mental Health Model (PMH) was designed to ameliorate the barriers that prevent adequate diagnoses and intervention. The PMH is a culturally sensitive, short-term telemedicine, and collaborative care intervention for addressing depression among Mexican American mothers. It attends to sociocultural and socioeconomic dimensions and is delivered by trained mental health advisors within obstetric care settings. This article describes the feasibility and acceptability of utilizing the PMH. Participants (n=79) were selected from a first year ongoing randomized trial in community obstetric clinics. The intervention seems feasible and acceptable; low-income Latinas, identified as depressed during the perinatal period, reported having access to a range of appropriate community services and high satisfaction.

Depression among parents of children with disabilities.

Abstract: We examined the rate of depression among 110 parents of children with disabilities and tested a model to determine the unique factors associated with parental depression. Consenting parents completed measures of depression, family satisfaction, physical health, problem-solving abilities, stress appraisals, and child functional impairment. Participants were categorized as depressed or nondepressed based on their responses to the Patient Health Questionnaire (PHQ9; Kroenke, Spitzer, & Williams, 2001). Nineteen percent of the parents met screening criteria for depression. Regression analyses revealed that threat appraisals, poorer physical health, and lower family satisfaction were uniquely associated with depression status with 83.3% accuracy. These findings highlight the importance of family satisfaction, problem solving ability, physical health, and the influence of appraisal processes on depression among parents of children with disabilities.

Therapeutic alliance and treatment outcome in the primary care behavioral health model

Abstract: The current study investigated therapeutic alliance and clinical improvement within an integrated primary care behavioral health model. Participants included 542 primary care patients seen in two large family medicine clinics. Mental health symptoms and functioning were assessed using the 20-item Behavioral Health Measure (Kopta & Lowery, 2002) at the beginning of each patient appointment. Therapeutic alliance was measured with the Therapeutic Bond Scale (CelestHealth Solutions, 2008) following an initial appointment with one of 22 behavioral health consultants (BHCs). Primary care patients rated their therapeutic alliance following a first appointment with a BHC as statistically stronger than alliance ratings from a previously reported sample of outpatient psychotherapy patients after the second, third, and fourth psychotherapy sessions (Kopta, Saunders, Lutz, Kadison, & Hirsch, 2009). Results of a bootstrapped linear regression analysis indicated that therapeutic alliance assessed after the first primary care behavioral health appointment was not associated with eventual clinical change in mental health symptoms and functioning. A strong therapeutic alliance was able to be formed in a primary care behavioral health modality. This exceeded the magnitude found in outpatient psychotherapy alliance ratings. Early therapeutic alliance was unrelated to overall clinical improvement in primary care.

Table for two: diabetes distress and diet-related interactions of married patients with diabetes and their spouses.

Abstract: In adjusting to chronic illness, patients often negotiate new or altered daily routines within a dynamic family context. Yet, the responses of family members to the disease and its management are understudied. The authors investigated patients with Type 2 diabetes and their spouses (N = 55 couples) and examined the association of diet-related interactions (i.e., diet-related support, diet-related pressure, and frequency of sharing meals together) with each partner's adjustment to the illness context (i.e., diabetes distress). All spouses (100%) reported providing some type of diet-related support to their partners with diabetes in the past month, and many reported exerting pressure to improve their partners' diet choices (60%). In addition, many couples (64%) indicated that they frequently shared meals together in the past month. For spouses, their provision of diet-related pressure was associated (positively) with their diabetes distress. Frequently sharing meals was associated with less diabetes distress among patients, even after controlling for their glycemic control and diet adherence. Findings reveal that spouses of patients with diabetes are actively involved in illness management with their partners, and these activities are associated with their own diabetes distress and with that of their ill partners.

Toward a new understanding of risk perception among young female BRCA1/2 "previvors".

Abstract: The quantitative risk of cancer among BRCA1/2 gene mutation carriers is generally well-understood, and can be communicated clearly to potential and known mutation carriers during the genetic risk assessment, education, and testing process. The extent to which individual mutation carriers feel vulnerable to cancer is a more complex dynamic with a powerful effect on risk-management decision-making; however, these decisions are not the products of straightforward personal assessment of one's quantitative probability of being diagnosed with cancer. We undertook this National Cancer Institute study to broaden understanding of the lived experiences of women who learn early in the life course that they carry a BRCA1/2 mutation. Our data indicate that the relationship between perceived risk and risk-management decisions is not direct, that is, several nononcologic components of risk are also integral to women's management decision-making. High-risk women commonly utilize self-perceived cancer risk to shape their decision-making and communication about various tasks of young adulthood, including differentiation from family of origin, establishing a permanent couple relationship, and family formation. Risk-management is also an important domain in which they strive to take control of their lives by actively participating in management choices. By understanding how these complex dynamics fit together, care providers can better guide, counsel, and support high-risk women as they struggle to balance legitimate risk-reduction needs with the desire to live a normal life. Here we present data from our qualitative research to aid in this effort.

A patient centered care plan in the EHR: Improving collaboration and engagement.

Abstract: Patients attempting to manage their chronic conditions require ongoing support in changing and adopting self-management behaviors. However, patient values, health goals, and action plans are not well represented in the electronic health record (EHR) impeding the ability of the team (MA and providers) to provide respectful, ongoing self-management support. We evaluated whether a team approach to using an EHR based patient centered care plan (PCCP) improved collaborative self-management planning. An experimental, prospective cohort study was conducted in a family medicine residency clinic. The experimental group included 7 physicians and a medical assistant who received 2 hr of PCCP training. The control group consisted of 7 physicians and a medical assistant. EHR charts were analyzed for evidence of 8 behavior change elements. Follow-up interviews with experimental group patients and physicians and the medical assistant assessed their experiences. We found that PCCP charts had more documented behavior change elements than control charts in all 8 domains (p < .001). Experimental group physicians valued the PCCP model and suggested ways to improve its use. Patient feedback demonstrated support for the model. A PCCP can help team members to engage patients with chronic illnesses in goal setting and action planning to support self-management. An EHR design that stores patient values, health goals, and action plans may strengthen continuity and quality of care between patients and primary care team members. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Enhancing maternal depression recognition in health care settings: a review of strategies to improve detection, reduce barriers, and reach mothers in need.

Abstract: Maternal depression is a major public health concern in the United States affecting mothers, children, and families. Many mothers experience depression, and exposure to maternal depression can put children at increased risk for psychopathology and poor psychosocial development. Early recognition of maternal depression is a critical step in promoting healthy development and preventing adverse outcomes in children and families. In this review, we examine some of the major barriers that mothers face in seeking help for depression; discuss optimal settings in which to implement maternal depression screening; review available depression screening tools for identifying mothers in need of care; discuss steps providers can take after screening; examine barriers to screening; and present information about promising initiatives developed to address these barriers.

It's a privilege to smile: impact of cleft lip palate on families.

Abstract: In this article we describe prior cross-sectional and longitudinal research conducted with children who were born with cleft lip and/or palate and their families in the United States and internationally. The findings and clinical implications from different times and cultures are synthesized using the Biopsychosocial Model. Our primary aim is to summarize the attachment styles, cognitive, psychological and social functioning, self-concept, neurological functioning, and speech difficulties prevalent among individuals who are born with cleft lip/palate at different developmental stages (e.g., infancy, toddler, childhood, adolescence). Additionally, bystander reactions to the speech and appearance of individuals coping with cleft lip and/or palate and its effects on the family are described. Finally we examine the diversity of samples from prior clinical research and provide clinical recommendations for more collaborative family-based practice among medical and mental health providers treating families coping with cleft lip and/or palate.

Working toward financial sustainability of integrated behavioral health services in a public health care system.

Abstract: The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

“An Effect That is Deeper Than Beating” Family Violence in Jordanian Women

Abstract: This study informs healthcare approaches to gender-based family violence through focus groups with Jordanian women. The authors conducted a thematic qualitative analysis of 12 focus groups among 70 married, divorced, or widowed women about their experiences and beliefs regarding family violence. Five themes relevant to healthcare providers were identified. Three of the themes addressed participant-perceived causes of gender-based family violence: 1) unmet gender role expectations, 2) stigma and social norms, and 3) extended family roles. The fourth theme reflects effects on victims. The fifth theme reflects protective qualities and help seeking behaviors. The themes identified in the analysis reveal multiple ways that gender-based family violence can contribute to health problems and that it can be kept secret by Jordanian women as patients. Potential clues are described for the violence which may not be typically explored in a medical encounter. Additional ways that Jordanian families may seek help from other family or clergy instead of police and family violence agencies are described. Implications of these results for healthcare providers who care both for Jordanians and Arab immigrants in Western cultures are discussed.

Promoting self-management in diabetes: efficacy of a collaborative care approach.

Abstract: Diabetes is a leading cause of death and is estimated to cost the United States 90 billion dollars annually. Increasing patient self-management skills has been shown to improve outcomes in patients with Type II diabetes. Promotion of shared decision-making between patient and provider is a core element of collaborative care and is especially well suited for increasing patient self-management. Research trials to date have been limited in demonstrating how self-management promotion can be fully integrated into primary care practices. Demonstration of the impact of this approach is needed. This study involves 22 randomly assigned physicians across three family medicine clinics to either provide usual care or work with a part-time collaborative care therapist in their clinic serving as an outreach health coach for their diabetic patients. Each outreach health coach met with each physician in the intervention group to identify patients most in need of intervention, sent identified patients a video on diabetes management, and called to encourage video viewing and discuss any patient-perceived barriers to self-management. Initial markers of patient activation in self-management, patients' video-viewing behavior, and health care encounters in the subsequent 6 months were compared between groups. Results showed that patients targeted by an outreach health coach were more likely to view the video, be seen by their primary care physician (PCP) within 6 months, and have disease-relevant laboratory tests performed than patients receiving usual care from their PCP (p < .05). This approach, linking PCPs with collaborative care staff, is viewed as expanding the engagement of PCPs with the collaborative team for superior patient health outcomes.

Teaching adaptive leadership to family medicine residents: what? why? how?

Abstract: Health care reform calls for patient-centered medical homes built around whole person care and healing relationships. Efforts to transform primary care practices and deliver these qualities have been challenging. This study describes one Family Medicine residency's efforts to develop an adaptive leadership curriculum and use coaching as a teaching method to address this challenge. We review literature that describes a parallel between the skills underlying such care and those required for adaptive leadership. We address two questions: What is leadership? Why focus on adaptive leadership? We then present a synthesis of leadership theories as a set of process skills that lead to organization learning through effective work relationships and adaptive leadership. Four models of the learning process needed to acquire such skills are explored. Coaching is proposed as a teaching method useful for going beyond information transfer to create the experiential learning necessary to acquire the process skills. Evaluations of our efforts to date are summarized. We discuss key challenges to implementing such a curriculum and propose that teaching adaptive leadership is feasible but difficult in the current medical education and practice contexts.

A medical home: changing the way patients and teams relate through patient-centered care plans.

Abstract: The patient-centered medical home model incorporates patient-centered care as a central tenet and espouses the health care team partnering with an engaged patient. The tools to accomplish this type of care have not evolved along with these values. This report describes how the adoption and use of a patient-centered care plan (PCCP) document enhanced care for complex patients and changed the relationships with health team members. The PCCP was used in a residency-affiliated community hospital, group family medicine site and provided patient-centered, goal-directed care for complex patients. Use of the PCCP changed the patient-team relationship, showing that this care plan document can support the practice of the patient-centered medical home model by enhancing patient-centered, coordinated, comprehensive care. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

"My funky genetics": BRCA1/2 mutation carriers' understanding of genetic inheritance and reproductive merger in the context of new reprogenetic technologies.

Abstract: Deleterious mutations in the BRCA1/BRCA2 genes elevate lifetime risk of breast and ovarian cancer. Each child of a mutation-positive parent has a 50% chance of inheriting it. Preimplantation genetic diagnosis (PGD) permits prospective parents to avoid the birth of a BRCA-mutation-positive child, introducing predictability into a process historically defined by chance. This investigation explored how BRCA1/2 mutation carriers understand genetic inheritance and consider a child’s inheritance of a BRCA1/2 mutation, given the opportunities that exist to pursue PGD. Thirty-nine female and male BRCA1/2 mutation carriers of reproductive age were recruited from urban cancer and reproductive medical centers. Participants completed a standardized educational presentation on PGD and prenatal diagnosis, with pre- and posttest assessments. An interdisciplinary team of qualitative researchers analyzed data using grounded theory techniques. Participants expressed the belief that reproduction yields children with unique genetic strengths and challenges, including the BRCA1/2 mutation, family traits for which predictive tests do not exist, and hypothetical genetic risks. Participants expressed preference for biologically related children, yet stated their genetically “well” partner’s lineage would be marred through reproductive merger, requiring the well partner to assume the burden of the BRCA1/2 mutation via their children. Participants expressed diverse views of genetically “well” partners’ participation in family planning and risk management decisions. Pressure to use reprogenetic technology may grow as genetic susceptibility testing becomes more widely available. Work with individuals and couples across the disease spectrum must be attuned to the ways beliefs about genetic inheritance play into reproductive decision-making.

Collaboration in the presence of an electronic health record.

Abstract: Recent laws in the United States incent healthcare practices to adopt electronic health records (EHRs). While there is extensive research related to EHRs generally, there is a dearth of EHR research specific to collaborative care settings. This study reports responses from 101 collaborative care offices who completed a 13-question online survey. The mixed-methods analysis provides insights as to the satisfaction, obstacles, and solutions to interdisciplinary collaboration in the presence of an EHR. Respondents reported highest satisfaction with medical billing, interdisciplinary communication, and scheduling. Satisfaction was lower as it relates to time consumption, difficult learning curve, creation of appointment notes, and health registries. This research reveals varied and conflicting approaches to addressing confidentiality and HIPAA within the EHR. Recommendations for improving EHR to better support collaborative care include the addition of modules common in mental health-specific EHR, enhanced tracking of mental health outcomes, templates for joint appointments, and improvements in population-based registry functions.

The Individual and Combined Influence of the ‘Quality’ and ‘Quantity’ of Family Meals on Adult Body Mass Index

Abstract: Although there is a well-established literature showing a positive association between the frequency of family meals and child and adolescent healthful dietary intake and lower body mass index (BMI), little is known about the association between family meal frequency (quantity) and adult health outcomes and whether quality (distractions) of family meals influences adult BMI. This study investigates the association between the quantity and quality of family meals and adult BMI. Data were from a nationally representative sample of 4,885 adults ages 25 to 64 years (56% female), from which an analytic sample of 1,779 parents was drawn for the current study. Multiple linear regression was used to test the relationship between family meal frequency and quality of family meals and adult BMI, controlling for sociodemographics. Interactions between family meal quantity and quality were also examined. The quantity of family meals and the quality of family meals were both independently related to adult BMI. Specifically, the frequency of family meals was associated with lower adult BMI and lower quality of family meals was associated with higher adult BMI. The interaction between quantity and quality was not statistically significant. Results suggest that both the quantity and quality of family meals matter for adult BMI, but one is not dependent on the other. Health care providers who work with families may want to consider promoting the importance of the quality and quantity of family meals to benefit the entire family.

Stress spillover of health symptoms from healthy spouses to patient spouses in older married couples managing both diabetes and osteoarthritis.

Abstract: Many studies examining illness within marriage have investigated how illness in one spouse influences the other spouse. In later-life marriages, where both spouses are more likely to have health challenges, there is an increased likelihood that health symptoms from both spouses affect each other. In the current study we examined how health symptoms in a "healthy" spouse may exacerbate health problems in a partner (the patient) who is managing multiple chronic illnesses. Surveys were collected across 14 days from 27 later-life couples where patients had both diabetes and osteoarthritis. Results indicated that higher healthy spouse symptoms were generally associated with higher patient symptoms, suggesting a spillover effect. Spouse reports of positive and negative mood were inversely linked with patient health outcomes. Spouse reports of higher positive marital interactions were surprisingly linked with higher patients' arthritis activity and activity limitations, possibly indicating a compensatory effect where marital interactions increase with symptoms. Daily spouse reports of positive marital interactions and mood were linked with patient health outcomes even after the spillover of health symptoms was taken into account.

Understanding intimate partner violence dynamics using mixed methods.

Abstract: Trauma research has employed both quantitative and qualitative methods, but only recently, have mixed method studies begun to appear in the trauma literature. The purpose of this case series was to demonstrate the value of mixed method approaches to studying dynamics among cases involving intimate partner violence (IPV). Of the 16 women in abusive relationships who completed daily reports of the household violence and environment over an 8-week period, three cases were chosen for discussion because they provided near complete quantitative data, rich qualitative data, and a "clear" dynamic pattern. These three cases demonstrate that, through the combination of quantitative and qualitative methods, a rich picture of individual IPV dynamics can be obtained, often unique to the marital relationship and context.

Caregiving load and pediatric asthma morbidity: conflict matters.

Abstract: Asthma is one of the most prevalent chronic illnesses among children in the United States and it disproportionately affects members of minority groups living in low-income and urban environments. In these environments, illness-related stressors are often experienced alongside a variety of family and social stressors, and parents may carry significant additional caregiving responsibilities over and above their child's asthma management. Participants in the current study included 23 girls and 22 boys, all diagnosed with asthma and living in low-income, urban neighborhoods; 85% of participants were members of ethnic minority groups. This study utilized a family systems framework to examine links among parents' caregiving responsibilities, parent-child conflict, and asthma morbidity. Caregiving load refers to the number of children and adults for whom the parent endorsed caregiving responsibilities. Two indicators of asthma morbidity were assessed, including asthma-related restrictions in the family's activities and the child's asthma quality of life. The findings of this study suggested a pivotal role of parent-child conflict in predicting children's and families' asthma-related morbidity. Higher levels of parent-child conflict were directly associated with higher levels of family activity restriction. Interestingly, under conditions of high parent-child conflict, higher caregiving load was associated with lower pediatric quality of life, but under conditions of low parent-child conflict, higher caregiving load was associated with higher quality of life. Implications of these findings for asthma treatment programs are discussed.

Establishing the Collaborative Care Research Network (CCRN): a description of initial participating sites.

Abstract: Collaborative care has increased dramatically in the past decade, yet the variability in collaborative strategies and the diversity of settings in which collaboration is being implemented make it difficult to assess quality and outcomes. Therefore, three aims were addressed in the current study: (a) describe and characterize the sites in the Collaborative Care Research Network (CCRN), (b) identify factors associated with practices' self-identified collaborative care model (e.g., coordinated, integrated, care management), and (c) identify limitations of available survey data elements so as to propose additional elements for future surveys. Initial (CCRN) sites completed surveys regarding several organizational factors (e.g., setting type, size of patient population, number of behavioral health providers). Results from 39 sites showed significant heterogeneity in self-identified type of collaborative care model practiced (e.g., integrated care, coordinated care), type of practice setting (e.g., academic, federally qualified health center, military), size of clinic, and ratio of behavioral health providers to medical providers. This diversity in network site characteristics can provide a rich platform to address a number of questions regarding the current practice of collaborative care. Recommendations are made to improve future surveys to better understand elements of the patient-centered medical home and the role it may play in outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

A Retrospective Study Predicting Psychological Vulnerability in Adult Daughters of Breast Cancer Patients

Abstract: This study was an attempt to identify vulnerability factors in two cohorts of daughters of breast cancer patients. One cohort consisted of daughters whose mothers survived breast cancer and the other consisted of daughters whose mothers died from breast cancer. The results revealed significant main effects. Greater caretaking involvement was associated with higher levels of cancer-related grief. Maternal loss to breast cancer predicted higher levels of cancer-related depression. Also, a history of a depression diagnosis in the daughters was associated with current depressive symptoms. Several significant interactions also emerged. Survival status of the mother and level of daughters' involvement in mother's breast cancer was shown to significantly affect the daughters' current depressive symptoms. Daughters who reported the lowest level of involvement with their mother's breast cancer reported the highest level of current depressive symptoms. Daughters who were less than 12 years of age at the time of their mother's diagnosis reported significantly higher current state anxiety than daughters who were 12 to 19 at the time of their mother's diagnosis. Daughters whose mothers died from breast cancer, who also had a past diagnosis of depression, reported significantly higher levels of cancer-related depression than daughters without a past diagnosis of depression. We concluded that maternal death among daughters who reported very low caretaking involvement reflects the most significant vulnerability to show current depressive symptoms. We also concluded that daughters possessing potential genetic vulnerability to depression are the most sensitized to traumatic life events such as maternal illness and death.

Collaboration with medical professionals in clinical practice: pediatric abdominal pain as a case example.

Abstract: Pediatric abdominal pain is a common childhood complaint. Available conceptualizations of the condition point toward an interdisciplinary approach to care as having the highest utility. The current study sets out to describe practice patterns among psychologists treating pediatric abdominal pain, the degree to which such practitioners engage in collaborative behaviors, barriers they experience to collaboration, and their overall satisfaction with their collaborative efforts. A survey of American Psychological Association members revealed that psychologists are engaging in the treatment of pediatric abdominal pain in high numbers and that those practitioners who find ways to engage in collaboration consistent with an interdisciplinary approach are more satisfied with their collaborations. The majority of barriers to collaboration appeared due to inflexibility in the health care system rather than a dispositional barrier on the part of a physician, patient, or the psychologist. Psychologists practicing in medical settings receive some relief from the systemic barriers experienced by psychologists in other settings.

Teaching the value of continuity of care: a case conference on long-term healing relationships.

Abstract: The Continuity Case Conference provides a model for teaching family medicine residents the value, importance, and impact of developing long-term doctor-patient relationships. A resident's presentation of challenging patient cases and the ensuing group interaction with resident peers, faculty, and medical staff are designed to offer residents alternate perspectives on complex, multiproblem cases while validating the often emotional process of patient care. This learning model is designed to demonstrate how a physician, in the context of the cumulative progression of contacts with a patient, can better manage myriad health issues, chronic and acute, and improve patient outcomes. The description of the 1-hr, once-a-month conference format contained herein includes details on preconference preparation, examples.