Showing papers in "Families, Systems, & Health in 2015"

Financial and employment impact of intellectual disability on families of children with autism.

Abstract: Families of children with autism spectrum disorder (ASD) endure significant financial and employment burden because of their children's numerous needed services. The study objective is to describe additional impact on families of children with intellectual disability (ID) in addition to ASD. The study is a secondary data analysis of the 2009-2010 National Survey of Children with Special Health Care Needs. Children whose parents answered "yes" when asked whether their child had ASD or ID were classified as having ASD alone (unweighted n = 2,406), ID alone (unweighted n = 1,363), or both ASD/ID (unweighted n = 620). Bivariate and multivariate analyses compared study outcomes of family financial and caregiver burden using ASD as the reference group. All analyses were weighted using person-level estimates. Of children with ASD, 24% also had ID. More than half of caregivers of children with ASD/ID reported financial difficulty (52%) and having to stop work to care for their child (51%). Compared with ASD alone, caregivers of children with both ASD/ID were more likely to report financial difficulty (aOR 1.65, 95% CI 1.10-2.46), cutting work hours (aOR 1.43, 95% CI .98-2.08), and stop working (aOR 2.32, 95% CI 1.57-3.43). No differences were found between caregivers of children with ASD only and ID only. We conclude that having ID in addition to ASD may be associated with greater negative impact on family financial and employment burden. Recognition of ID in addition to ASD is important to tailor the clinical approach and sufficiently support families.

Health disparities among youth with type 1 diabetes: A systematic review of the current literature.

Abstract: INTRODUCTION Research in pediatric Type 1 diabetes (T1D) has reliably identified differences in health outcomes based on race/ethnicity and socioeconomic status (SES). Racial/ethnic minority and/or low-SES youth consistently display poorer physical health and psychological functioning than racial/ethnic majority and higher-SES youth. The purpose of this review is to better understand health disparities in T1D by race/ethnicity and SES, and to provide recommendations for researchers based on these findings. METHODS Articles were obtained from PsycINFO, PubMed, and Web of Knowledge with search terms: "Type 1 diabetes," "ethnic," "pediatric," "race/ethnicity," "race," "socioeconomic status," "SES," and "income." Criteria for inclusion were (a) Type 1 diabetes cases, (b) child or adolescent samples, (c) information about health or psychosocial outcomes grouped by race/ethnicity or SES, (d) no intervention data, (e) peer-reviewed, (f), English-language, and (g) published in an academic journal. RESULTS Twenty-seven articles reported on health outcomes and 4 articles reported on psychosocial outcomes. Across 16 studies, racial/ethnic minority youth displayed higher HbA1c levels compared to Caucasian youth. Eighteen studies reported that lower-SES youth had higher HbA1c levels than higher-SES youth. Four studies found racial/ethnic minority youth and lower-SES youth had poorer psychological functioning than Caucasian youth or higher-SES youth. DISCUSSION Findings from our review suggest an association between race/ethnicity, SES, and health outcomes in pediatric T1D. Researchers should consider developing interventions that take into account factors which may place children from racial/ethnic minority and lower-SES backgrounds at risk for poor metabolic control and emotional functioning. Future research should examine causative mechanisms of health disparities.

Building teams in primary care: A practical guide.

Abstract: Introduction Primary care is changing to a team-based model. A number of high-performing primary-care practices in the United States have succeeded in making the transition to team-based care. Method Site visits were conducted to 29 high-performing primary-care practices. Observations made in these practices were summarized for common elements exhibited by care teams. A limited literature search was done to review corroborating evidence. Results Teams observed in the 29 practices were found to exhibit 9 elements: a stable team structure, colocation, a culture shift in progress from physician-driven to team-based care, defined roles with training and skill checks to reinforce those roles, standing orders and protocols, defined workflows and workflow mapping, staffing ratios adequate to facilitate new roles, ground rules, and modes of communication, including team meetings, huddles, and minute-to-minute interaction. Discussion These 9 elements may be helpful to practices making the transition to team-based care.

Measuring teamwork in primary care: Triangulation of qualitative and quantitative data.

Abstract: This article describes the triangulation of qualitative dimensions, reflecting high functioning teams, with the results of standardized teamwork measures. The study used a mixed methods design using qualitative and quantitative approaches to assess teamwork in 19 Family Health Teams in Ontario, Canada. This article describes dimensions from the qualitative phase using grounded theory to explore the issues and challenges to teamwork. Two quantitative measures were used in the study, the Team Climate Inventory (TCI) and the Providing Effective Resources and Knowledge (PERK) scale. For the triangulation analysis, the mean scores of these measures were compared with the qualitatively derived ratings for the dimensions. The final sample for the qualitative component was 107 participants. The qualitative analysis identified 9 dimensions related to high team functioning such as common philosophy, scope of practice, conflict resolution, change management, leadership, and team evolution. From these dimensions, teams were categorized numerically as high, moderate, or low functioning. Three hundred seventeen team members completed the survey measures. Mean site scores for the TCI and PERK were 3.87 and 3.88, respectively (of 5). The TCI was associated will all dimensions except for team location, space allocation, and executive director leadership. The PERK was associated with all dimensions except team location. Data triangulation provided qualitative and quantitative evidence of what constitutes teamwork. Leadership was pivotal in forging a common philosophy and encouraging team collaboration. Teams used conflict resolution strategies and adapted to the changes they encountered. These dimensions advanced the team's evolution toward a high functioning team.

Shared presence in physician-patient communication: A graphic representation.

Abstract: Shared presence is a state of being in which physicians and patients enter into a deep sense of trust, respect, and knowing that facilitates healing Communication between physicians and patients (and, in fact, all providers and recipients of health care) is the medium through which shared presence occurs, regardless of the presenting problem, time available, location of care, or clinical history of the patient Conceptualizing how communication leads to shared presence has been a challenging task, however Pathways of this process have been routinely lumped together as the biopsychosocial model or patient, person, and relationship-centered care--all deceptive in their simplicity but, in fact, highly complex--or reduced to descriptive explications of one constituent element (eg, empathy) In this article, we reconcile these pathways and elements by presenting a graphic image for clinicians and teachers in medical education This conceptual image serves as a framework to synthesize the vast literature on physician-patient communication We place shared presence, the fundamental characteristic of effective clinical communication, at the center of our figure Around this focal point, we locate four elemental factors that either contribute to or result from shared presence, including interpersonal skills, relational contexts, actions in clinical encounters, and healing outcomes By visually presenting various known and emergent theories of physician-patient communication, outlining the flow of successful encounters between physicians and patients, and noting how such encounters can improve outcomes, physicians, other health care professionals, and medical educators can better grasp the complexity, richness, and potential for achieving shared presence with their patients

Celiac is a social disease: family challenges and strategies.

Abstract: Celiac disease is the most common autoimmune inherited disorder in the United States, affecting approximately 1% of the population. Little research exists on the impact of family processes on adherence to a gluten-free diet (GFD), the only treatment for celiac disease. The objective of this qualitative study was to examine the barriers that families with a celiac child face and the strategies they use to adhere to the recommended diet. In-depth interviews were conducted with 10 families with a child between the ages of 6 and 12 diagnosed with celiac disease. Grounded theory and narrative analysis were used to analyze interview transcripts. Social isolation and misunderstandings about celiac disease and the GFD emerged as the most significant barriers to diet adherence including the reproduction of traditional gender relations among parents. Diet adherence facilitators included various types of institutional and societal support and idiosyncratic family arrangements. Successful diet adherence strategies used by families included planning ahead and taking their own food to social functions. Family processes play a critical role in GFD adherence. Implications for health care clinicians working with families with a child with celiac disease are discussed.

Influence of a quality improvement learning collaborative program on team functioning in primary healthcare.

Abstract: Quality improvement (QI) programs are frequently implemented to support primary healthcare (PHC) team development and to improve care outcomes. In Ontario, Canada, the Quality Improvement and Innovation Partnership (QIIP) offered a learning collaborative (LC) program to support the development of interdisciplinary team function and improve chronic disease management, disease prevention, and access to care. A qualitative study using a phenomenological approach was conducted as part of a mixed-method evaluation to explore the influence of the program on team functioning in participating PHC teams. A purposive sampling strategy was used to identify PHC teams (n = 10), from which participants of different professional roles were selected through a purposeful recruitment process to reflect maximum variation of team roles. Additionally, QI coaches working with the interview participants and the LC administrators were also interviewed. Data were collected through semistructured telephone interviews that were audiotaped and transcribed verbatim. Thematic analysis was conducted through an iterative and interpretive approach. The shared experience of participating in the program appeared to improve team functioning. Participants described increased trust and respect for each other's clinical and administrative roles and were inspired by learning about different approaches to interdisciplinary care. This appeared to enhance collegial relationships, collapse professional silos, improve communication, and increase interdisciplinary collaboration. Teamwork involves more than just physically grouping healthcare providers from multiple disciplines and mandating them to work together. The LC program provided opportunities for participants to learn how to work collaboratively, and participation in the LC program appeared to enhance team functioning.

Use of a resiliency framework to examine pregnancy and birth outcomes among adolescents: A qualitative study.

Abstract: INTRODUCTION Adolescent childbearing has been viewed as a social, political, and public health priority since the 1970s. Research has primarily focused on the negative consequences of teen pregnancy; less research has explored factors associated with healthy pregnancy and birth experiences in this population. METHOD Using open-ended and qualitative techniques, researchers performed individual interviews with 15 adolescent mothers (15 to 19 years of age) recruited from a Women's and Children's Clinic in Southern Louisiana, who had experienced a healthy pregnancy and bore a full-term, normal birth weight infant. We used a resiliency framework to identify factors that may have supported positive health outcomes despite risks associated with low-income and/or marginalized minority status. RESULTS A total of 15 mothers of multiple racial/ethnic identities were included in the analysis. Mothers discussed potential protective factors that we classified as either assets (internal factors) or resources (external factors). Mothers demonstrated strong assets including self-efficacy and self-acceptance and important resources including familial support and partner support during pregnancy which may have contributed to their resiliency. DISCUSSION Ensuring access to social and structural supports as well as supporting adolescent-friendly health and social policies may be key to promoting healthy maternal and infant outcomes among young women who become pregnant. (PsycINFO Database Record

Team Training in Obstetrics: A multi-level evaluation

Abstract: INTRODUCTION Obstetric complications and adverse patient events are often preventable. Teamwork and situational awareness (SA) can improve detection and coordination of critical obstetric (OB) emergencies, subsequently improving decision making and patient outcomes. The purpose of this study was to assess the effectiveness of a team training intervention in improving learning and transfer of teamwork, SA, decision making, and cognitive bias as well as patient outcomes in OB. METHOD An adapted TeamSTEPPS training program was delivered to OB clinicians. Training targeted communication, mutual support, situation monitoring, leadership, SA, and cognitive bias. We conducted a repeated measures multilevel evaluation of the training using Kirkpatrick's (1994) framework of training evaluation to determine impact on trainee reactions, learning, transfer, and results. Data were collected using surveys, situational judgment tests (SJTs), observations, and patient chart reviews. RESULTS Participants perceived the training as useful. Additionally, participants acquired knowledge of communication strategies, though knowledge of other team competencies did not significantly improve nor did self-reported teamwork on the unit. Although SJT decision accuracy did not significantly improve for all scenarios, results of behavioral observation suggest that decision accuracy significantly improved on the job, and there was a marginally significant reduction in babies' hospital length of stay. DISCUSSION These findings indicate that the training intervention was partially effective, but more work needs to be done to determine the conditions under which training is most effective, and the ways in which to sustain improvements. Future research is needed to confirm its generalizability to additional OB units and departments.

Association between diabetes treatment adherence and parent-child agreement regarding treatment responsibilities

Abstract: When primary responsibility for Type 1 diabetes (DM1) treatment adherence transfers from parents to adolescents, glycemic control often suffers. Low rates of treatment adherence during this transition are possibly attributable to decreased parental involvement, disagreements between parents and children regarding treatment responsibilities, and increased family conflict. The current investigation assessed the relationships between each of these variables and glycemic control among youth diagnosed with DM1. Parent and child report questionnaires were completed by 64 parent-child dyads (ages 8-18) with a child diagnosed with DM1. HbA1c readings served as measures of glycemic control. Parental involvement in their children's treatment was reported to decline with age, however absolute levels of parent involvement were not significantly correlated with youth HbA1c levels. Parent-child agreement regarding treatment responsibility and reports of diabetes-related conflict were significant predictors of glycemic control. Results support previous findings implicating parent-child agreement regarding treatment responsibilities and family conflict as predictors of treatment adherence among youth with DM1. The current study found this relationship to be significant for a larger population of children for which past research has failed to find such an effect. Taken together, these findings suggest further research is warranted to identify effective methods for transferring treatment responsibilities from parents to children.

Physician actions following a positive PHQ-2: implications for the implementation of depression screening in family medicine practice.

Abstract: Systematic screening of depression in primary care settings that have adequate follow-up and treatment is recommended. The Patient Health Questionnaire (PHQ-9) was developed as a depression screening measure for use in primary care. The PHQ-2, which includes just 2 items from the PHQ-9, is designed to be used as a first line depression screening measure, to be followed by the full PHQ-9 when a patient screens positive. However, completion of the first step in the process (PHQ-2) does not necessarily lead to completion of the second step (administration of the PHQ-9 when the PHQ-2 is positive), even when treatment and follow-up are available. The objective of the current study was to describe family medicine physicians' actions following a positive PHQ-2 and factors that affect their use of depression screening measures and treatment decisions. A retrospective chart review of 200 family medicine patients who screened positive on the PHQ-2 during an office visit was conducted. Additionally, 26 family medicine physicians in the practice were surveyed. Only 5% of patients with positive PHQ-2 scores were administered a PHQ-9. Physicians relied on their clinical judgment and prior knowledge about the patient's depression status to inform treatment decisions and cited time constraints and competing demands as reasons for not administered the PHQ-9. Physicians tended to treat depression with adequate doses of antidepressants and counseling. PHQ-2 screening did not necessarily lead to further evaluation, systematic follow-up, or changes in treatment. Implications for the implementation of depression screening in primary care settings are discussed.

Patient care complexity as perceived by primary care physicians.

Abstract: It is important for primary care providers (PCPs) to be able to identify “patient care complexity” when confronted with it in their practices in order for them to properly treat these patients and to obtain appropriate reimbursement for their care. In general these are patients who for various reasons do not participate effectively in their personal care and require extra time and resources to achieve even minimal therapeutic objectives (Peek, Baird, & Coleman, 2009). The patient, in turn, may experience frustration with the medical care system. Underlying these clinical dilemmas are contextual issues in patients’ lives that interfere with self-activation and proper self-care. The contextual issues can be intrinsic to the patient (e.g., literary or language incompetence, co-occurring mental illness) or extrinsic (e.g., lack of social support, spousal abuse) (Weiner, 2004). Identifying patients who have complex care needs in the primary care setting is ever more important because the numbers of these patients are increasing (Turner & Cuttler, 2011; Weiss, 2007; Whittle & Bosworth, 2007), and many emerging health care reforms are aimed at improving services for these patients. The number of adults over 65 years of age is projected to reach 20% of the U.S. population by 2030, and these older adults have more health issues and almost four times the rate of hospitalization than their younger cohorts (CDC, 2007; He, Sengupta, Velkoff, & DeBarros, 2005). Despite increasing numbers of patients with complex care needs, a consensus definition for complexity is presently unavailable (Cohen et al., 2011; Peek et al., 2009; Turner & Cuttler, 2011; Whittle & Bosworth, 2007). In this paper “complexity” will be used to describe patient care complexity. Accurately defining complexity is essential in order to create interventions to improve patient care and to enable healthcare providers to be reimbursed properly for caring for these patients. Current definitions of complexity used in medical studies depend primarily on the simultaneous occurrence of multiple chronic medical conditions (Grembowski et al., 2014; Katon et al., 2010). However, experienced healthcare providers identify a spectrum of psycho-social-economic circumstances that impact a patient’s health (Peek et al., 2009; Shippee, Shah, May, Mair, & Montori, 2012; Weiner, 2004; Weiss, 2007). Customizing a patient’s care based on these circumstances has been described as “contextualization” (Weiner, 2004; Weiner et al., 2013). For the most part these psycho-social-economic contextual factors are not measured, codified in existing diagnoses, or accounted for in reimbursement for services (Weiner et al., 2013). In the course of efforts to improve the care of patients with complex care needs in the practices of a large primary care network, we encountered a gap between the practitioners’ perceptions of complexity and the definitions of complexity reported in the medical literature where most authors attributed complexity to patients with multiple medical diagnoses (Grembowski et al., 2014; Katon et al., 2010; Loeb, Bayliss, Biswanger, Candrian, & deGruy, 2011; Newcomer, Steiner, & Bayliss, 2011). Although multiple medical diagnoses may contribute to complexity, PCPs described various other contextual issues that may complicate the care of patients (Weiner, 2004; Weiner et al., 2013). European physicians have developed tools to assist practitioners with screening and identifying factors that contribute to complexity, including the INTERMED (de Jonge, Huyse, Slaets, Sollner, & Stiefel, 2005; Huyse et al., 1999; Huyse et al., 2001; Stiefel et al., 1999; Stiefel et al., 2006) and the COMPRI (Huyse et al, 2001). Peek et al. (2009) adapted the INTERMED tool (de Jonge et al., 2005; Huyse et al., 1999; Huyse et al., 2000; Stiefel et al., 1999; Stiefel et al., 2006) to assess complexity in primary care practices and created the Minnesota Complexity Assessment Method (MCAM). Although the MCAM includes assessment for several contextual factors that contribute to complexity, the tool was trialed by PCPs in a local clinic and was found to be too cumbersome and time consuming to be useful in clinical practice. Utilizing principles of action research (Svensson & Nielsen, 2006), we convened social scientists and PCPs with the aim of identifying and describing important dimensions of complexity. The purpose of this report is to describe the elucidation and validation of dimensions of complexity that were identified by PCPs and to assess the capacity of these items to discriminate between patients in their practices who did and did not require complex care.

Challenges in developing primary care physicians' motivational interviewing skills.

Abstract: INTRODUCTION Motivational interviewing (MI) skills are relevant for primary care providers (PCPs) who are responsible for caring for patients with diseases affected by behavior. There are significant challenges associated with developing PCP's MI skills. We report on an effort to document the acquisition of MI skills by PCPs using an objective measure of MI competence, the Motivational Interviewing Treatment Integrity (MITI) coding system. METHOD Eleven PCPs volunteered to participate in 6 MI workshops over a period of 6 months and to submit work samples between each of these workshops to be assessed with the MITI coding system. RESULTS Thirteen of the expected 55 work samples were submitted before the final workshop. A revised approach was implemented in which each participant completed 2 simulated patient encounters. None of the providers reached the MITI's Beginning Proficiency threshold of MI skill. DISCUSSION Six MI workshops were not sufficient to help motivated PCPs achieve Beginning Proficiency as measured by the MITI. Participants failed to submit most of the work samples for feedback on their MI practice, which may have contributed to their limited acquisition of MI skills. Helping PCPs develop MI skills likely requires more than participation in a series of workshops totaling 18 h. Questions remain about the feasibility of training PCPs to be competent in MI. Approaches such as use of simulated patients, peer observation, or specific protected time for obtaining work samples may be required. (PsycINFO Database Record

Growing up with an ill parent: An examination of family characteristics and parental illness features.

Abstract: Introduction Existing literature suggests that the children of ill parents are vulnerable to a variety of psychosocial difficulties such as depression and anxiety. The purpose of the current study is to investigate the impact of family characteristics (parental involvement, familial support, stress experienced as a result of parental illness) and parental illness features (severity, duration, recovery status, frequency of symptoms, course) on the psychosocial functioning (depression, anxiety, life satisfaction) of late adolescents who have grown up with an ill parent but no longer live with their parents. Method Participants were 71 college students with a parent who experienced a chronic medical condition while they were growing up. Participants provided information regarding family characteristics, parental illness features, and the impact of parental illness. Impact of parental illness was assessed using the Impact of Illness Scale. Participants also completed measures of depression, anxiety, and life satisfaction. Results Participants' reported impact of parent illness was positively correlated with participant depression and anxiety. Several family characteristics and parental illness features were significantly associated with participant psychosocial functioning. In particular, lower parental involvement was correlated with greater participant depression and anxiety, as well as lower life satisfaction. Discussion These findings extend our understanding of the impact of parental illness on late adolescents' psychosocial functioning. Results could have clinical applications for psychosocial interventions in children and families coping with chronic illness. (PsycINFO Database Record

Coping with intimate partner violence: qualitative findings from the study of dynamics of husband to wife abuse

Abstract: INTRODUCTION: Coping can be defined as an individual's efforts to manage a problem. In Intimate Partner Violence (IPV), coping depends heavily on relationship context, circumstances, and resource availability. The range of coping strategies utilized by women experiencing violence are not fully understood. METHOD: Two hundred female patients who screened positive for verbal or physical abuse were recruited from 6 primary care clinics in San Antonio. Subjects were instructed to complete a baseline survey, which included the COPE scale, as well as daily telephone reports, weekly contact with research staff, and an end-of-study survey. A total of 42 women completed an in-depth qualitative interview at the end of 3 months. RESULTS: Using a template approach to qualitative analysis, interview transcripts were analyzed and coded. "Coping" as a theme emerged independently and was categorized into 14 subcategories, according to the COPE scale; the most commonly endorsed themes from interviews were "avoidance" and "active coping." Previously undescribed methods of coping with IPV were also discovered using this approach, including "preventing escalation" and "ignoring." DISCUSSION: In a qualitative study of women living with IPV, coping emerged as an independent theme. We found that the women used methods not listed on the COPE standardized scale at least as often as more traditional categories. It is important for family medicine clinicians to be aware of the wide variety of coping mechanisms to best address safety planning. (PsycINFO Database Record Language: en

Diabetes knowledge in young adults: associations with hemoglobin A1C

Abstract: The purpose of this study was to quantify associations between hemoglobin A1C (A1C) and diabetes knowledge score using an assessment tool developed to evaluate the level of diabetes knowledge in young adults with Type 1 diabetes (T1DM) and their parent/primary caregiver. Seventy-five participants with T1DM, ages 15-22 years, completed questionnaires. Two 25-item questionnaires were developed: one for patient and one for caregiver. Linear regression quantified associations between correct items on the tools and participant A1C and demographic characteristics. Mean age of participants was 16.7 ± 1.7 years, diabetes duration 5.9 ± 4.2 years, 46.7% male, 74.7% Caucasian, 69.3% on multiple daily injections, and 30.7% on continuous subcutaneous insulin infusion therapy; 78.7% of parents/caregivers completed the questionnaire. A significant interaction was observed between patient and caregiver scores with A1C by diabetes duration. Among patients with diabetes <6 years, higher patient and caregiver scores were associated with lower A1C (-0.25 ± 0.11, p = .03 and -0.59 ± 0.19, p = .005, respectively) accounting for age, gender, race, therapy, and insurance. Neither patient nor caregiver score was associated with A1C in patients with diabetes duration ≥6 years. Better performance on a diabetes knowledge assessment (for both patient and the caregiver) was found to be associated with more favorable levels of glycemic control among young adults with diabetes <6 years. Additional evaluation of these questionnaires and novel interventions to enhance knowledge in this population are needed.

The Q-List manifesto: how to get things right in generalist medical practice.

Abstract: Checklists have become popular in medical practice since the publication of surgeon Atul Gawande's book, The Checklist Manifesto: How to Get Things Right. Based on his 26 years of practice as a family physician and informed by scholarly works from other professional disciplines, the author suggests that although checklists are helpful for promoting habitual reflection, they are limited in scope and meaning, and more suited for procedural undertakings than the bio-psycho-social-existential orientation of generalist practice. The author reviews the characteristics of generalist practice and suggests that clinicians develop a list of questions to help them recall and examine concepts key to the exploration and management of routine and challenging situations with patients. He proposes his own Question-List, or Q-List, and recommends its adaptation for use as a manifesto to the rich and engaging work of generalist medicine.

Please break the silence: Parents’ views on communication between pediatric primary care and mental health providers

Abstract: Introduction The purpose of this study was to gain a better understanding of parents’ preferences regarding the sharing of information between their children's primary care and mental health providers.

Mothers' use of blogs while engaged in family-based treatment for a child's eating disorder.

Abstract: INTRODUCTION We explore parents' use of blogs while engaged in family-based treatment (FBT), a form of treatment in which parents engage as the primary givers of care for a child's eating disorder. We sought to bring together emergent literature on the value of blogging for social support with a body of literature on caregiving for a child with an eating disorder and to understand how parents use blogs while engaged in FBT. METHOD We conducted a thematic analysis of 138 blog entries written by 5 mothers. RESULTS Two main themes emerged: the importance of support and shifts in parenting. Blogs detailed how parents actively seek to meet their needs during a difficult time using online interactions to bolster sources of support that exist offline. This intensive form of treatment also provoked shifts in parenting, which parents described on their blogs. Parents' blogs were rich with descriptions of their use of mutually reinforcing on- and offline support. DISCUSSION The unique context of the blogs allowed for access to data that were not generated for the purpose of research. Results add to the growing body of literature about parents' caregiving experiences and use of blogs for social support, and they offer implications for using online spaces as adjunct support for families. (PsycINFO Database Record

Don Bloch’s vision for Collaborative Family Health Care: Progress and next steps.

Abstract: BACKGROUND Don Bloch is the central figure in the origin story for the field of collaborative family health care; the journal Families, Systems, & Health; and for the Collaborative Family Healthcare Association (CFHA). He exerted extraordinary intellectual and practical leadership for all 3. He convened a national working session in 1994 that took stock of the field and set out next steps, one of which was to create the interprofessional organization dedicated to collaborative family health care that is now CFHA. PURPOSE As part of honoring Don Bloch's contributions to the field and this journal, this article sets out tenets of his original vision and traces next steps toward this vision generated by national groups between 1994 and 2014, showing what is the same or different over these 20 years, and especially what this means for the field going forward. METHOD Precepts of Don Bloch's original vision are drawn from his writings, including the briefing papers he prepared for the national Wingspread group convened in 1994, which also set out next steps for the field. These steps are then compared with next developmental steps for the field generated by CFHA conference attendees in 2004 and again in 2014, after reviewing the history of the organization and the field. CONCLUSION Much of Don Bloch's vision has remained relevant to health care transformation, with a number of areas showing significant accomplishment and acceptance, whereas others remain aspirational, and a few others arguably being more difficult to achieve now than when Don articulated them.

Effects of preventive family service coordination for parents with mental illnesses and their children, a RCT

Abstract: Children of parents with a mental illness (COPMI) are at increased risk for developing psychiatric disorders, especially when parenting is compromised by multiple risk factors. Due to fragmented services, these families often do not get the support they need. Can coordination between services, as developed in the Preventive Basic Care Management (PBCM) program, improve parenting and prevent child behavioral problems? This randomized controlled clinical trial (RCT) compared the effectiveness of PBCM with a control condition. Ninety-nine outpatients of a community mental health center were randomized to intervention or control. Primary outcomes included parenting quality (assessed by the HOME instrument), parenting skills (parenting skills subscale of FFQ), and parenting stress (PDH). Secondary outcomes are child behavioral problems (SDQ). Outcomes were assessed at baseline and after 9 and 18 months. Effects were analyzed by Repeated Measures Analysis of Variance. Most families were single-parent families belonging to ethnic minorities. The results of the first RCT on effects of PBCM suggest that this intervention is feasible and has a positive effect on parenting skills. There was no evidence for effects on the quality of parenting and parenting stress, nor preventive effects on child behavioral problems. Replication studies in other sites, with more power, including monitoring of the implementation quality and studying a broader palette of child outcomes are needed to confirm the positive effects of PBCM. Long-term prospective studies are needed to investigate if improved parenting skills lead to positive effects in the children in the long run.

The influence of nonresident fathers on adolescent and young adult cigarette smoking.

Abstract: Introduction In this analysis we examine the relationship between nonresidential father involvement with their children and adolescent smoking behavior using a nationally representative longitudinal dataset. We attempt to determine what influence, if any, nonresident fathers have in the development of this health risk behavior in their adolescent children while accounting for aspects of parenting and family life that have been hypothesized to also influence adolescent cigarette smoking. Method Data for this analysis come from the first 3 waves of the Longitudinal Study of Adolescent to Adult Health. Given the longitudinal nature of the data, we are able to ascertain whether nonresident father involvement affects adolescent cigarette smoking, an important advance in our understanding of the influence of fathers. Results We found that greater levels of nonresidential father involvement significantly decrease both the odds of participation in and the intensity of cigarette smoking, especially among girls. This influence is demonstrated not only in adolescence but persists into young adulthood. Discussion Our findings underscore the importance of adolescents' living arrangements and the role that nonresident fathers might play in influencing adolescent cigarette smoking, a health risk behavior of strong public health significance. Fathers make important contributions to the health and wellbeing of their children, and interventions focused on nonresident fathers in particular would likely be of significant help to the substance abuse prevention field. Interventions to support father involvement, particularly of nonresident fathers, with their children should be implemented as a preventive strategy to reduce the likelihood of adolescent cigarette smoking.

Parent psychopathology as a mediator of the relationship between anxiety and sleep problems in children.

Abstract: INTRODUCTION Sleep problems exert a negative impact on youths and their families. Parent and child mental health represent 2 posited, yet understudied, risk factors for sleep problems in youths. As such, this study sought to examine the role that parental psychopathology may play in mediating the relationship between child anxiety and sleep problems utilizing Internet sampling procedures. METHOD Parents (n = 83; 90.4% female) answered questions about their own mental health, and about their child's (n = 83; 77.1% female) anxiety and sleep. RESULTS Analyses found that parent anxiety and stress mediated the relationship between child anxiety and sleep problems. DISCUSSION This is the first study to examine the joint roles of parent psychopathology and child anxiety in explaining sleep problems in youths. Limitations notwithstanding, these results suggest that both parent- and child-level variables are important for developing a more comprehensive understanding of child sleep problems. Future areas of research are discussed.

Panel management, team culture, and worklife experience.

Abstract: Burnout and professional dissatisfaction are threats to the primary care workforce. We investigated the relationship between panel management capability, team culture, cynicism, and perceived "do-ability" of primary care among primary care providers (PCPs) and staff in primary care practices. We surveyed 326 PCPs and 142 staff members in 10 county-administered, 6 university-run, and 3 Veterans Affairs primary care clinics in a large urban area in 2013. Predictor variables included capability for performing panel management and perception of team culture. Outcome variables included 2 work experience measures--the Maslach Burnout Inventory cynicism scale and a 1-item measure of the "do-ability" of primary care this year compared with last year. Generalized Estimation Equation (GEE) models were used to account for clustering at the clinic level. Greater panel management capability and higher team culture were associated with lower cynicism among PCPs and staff and higher reported "do-ability" of primary care among PCPs. Panel management capability and team culture interacted to predict the 2 work experience outcomes. Among PCPs and staff reporting high team culture, there was little association between panel management capability and the outcomes, which were uniformly positive. However, there was a strong relationship between greater panel management capability and improved work experience outcomes for PCPs and staff reporting low team culture. Team-based processes of care such as panel management may be an important strategy to protect against cynicism and dissatisfaction in primary care, particularly in settings that are still working to improve their team culture.

Towards expanding the acute care team: Learning how to involve families in care processes.

Abstract: Introduction Effective teamwork is known to be important to improving health care outcomes. Current research often highlights teamwork among health care professionals without consideration of approaches to including family as part of the health care team. In this study, the authors assess family and provider openness to expanding the care team to include family participation and introduce the Family Involvement Menu as a tool to facilitate family engagement. Method They collected 37 family surveys and 37 clinician surveys to understand the perception, comfort level, experience, and interest of family and clinicians in including family in the care of the patient. The majority of family reported being interested and comfortable in participating in care (95% and 92%, respectively). Results The majority of clinicians considered family already to be part of the health care team (92%) though only 16% reported routinely inviting families to participate in direct patient care all the time. Multiple direct patient care activities were identified as promising opportunities for family engagement. Barriers to family engagement reported included the family being scared (19%), uncomfortable (19%), or unwilling (14%) or nurses not having enough time (14%) to involve families. Discussion Engaging family has the potential to increase nursing availability for other tasks, enhance relationship building, and is an opportunity to introduce early education for family, better preparing them for transition of care and discharge. The Family Involvement Menu supports family engagement and can be a strategy to include family members as part of the health care team.

The benefits of child-parent psychotherapy to marital satisfaction.

Abstract: Introduction Given the interdependent nature of relationships within the family system, the purpose of this study was to examine the potential role of child-parent psychotherapy (CPP) to extend its positive influence beyond the mother-child relationship within families challenged by maternal depression. Accordingly, we analyzed longitudinal associations between depressive symptoms and marital satisfaction over 3 years in order to evaluate if the benefits of CPP to mother-child attachment security might generalize within the family and indirectly benefit marital relationships. Method We tested our hypotheses in a randomized control trial of CPP (N = 159 families) to examine the intervention's efficacy in families with mothers with histories of depression since the target child's birth (Mage = 20.4 months, SD = 2.5; 56% boys). Results Using hierarchical linear modeling (HLM) with an actor-partner interdependence modeling (APIM) framework, the results supported our hypothesis as well as revealed significant associations between depressive symptoms and marital functioning. Specifically, shifts in mothers' depressive symptoms within specific waves of follow-up were associated with corresponding shifts in both their husbands' and their own relationship satisfaction in those same waves. After controlling for those effects, only mothers with a history of depression who received CPP demonstrated slight improvements in relationship satisfaction over the 3 years of the study, suggesting secondary benefits of CPP within the family system. Discussion Results are discussed in terms of the importance of examining therapeutic processes within the larger family system. Concerning future research, we also suggest examining potential mechanisms through which CPP might influence marital satisfaction. (PsycINFO Database Record

Body Image Mediates Negative Family Climate and Deteriorating Glycemic Control for Single Adolescents With Type 1 Diabetes

Abstract: INTRODUCTION Glycemic control declines during adolescence, as youth with diabetes struggle with pubertal changes and a changing social world. The present study tests whether body image mediates longitudinal links between family climate and changes in adolescent glycemic control. Mediation was hypothesized for nondating adolescents but not for dating adolescents, because the former are thought to remain more family oriented than the latter. METHOD Participants were German adolescents with Type 1 diabetes (51 girls, 58 boys; M = 15.84 years, SD = 1.44). Participants reported body image and family climate. Physicians assayed blood HbA1c levels (M = 8.22%, SD = 1.80%) to measure glycemic control. RESULTS For nondating adolescents, body image mediated associations between family climate and longitudinal changes in glycemic control. Poorer family climate was associated with poorer body image, which predicted deteriorating glycemic control. For dating adolescents, family climate was unassociated with changes in glycemic control. DISCUSSION Nondating adolescents may look to parents for feedback on body image, which affects how they manage the challenges of diabetes. Parents and practitioners alike should be alert to the fact that family climate continues to be an important determinant of adolescent adjustment, particularly for those who have not moved into romantic relationships. We know that body image matters to adolescents, but for some youth, body image may be the difference between health and serious physical problems. (PsycINFO Database Record

Developing patient-centered teams: The role of sharing stories about patients and patient care.

Abstract: Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further.

Clinician perspectives on working with health coaches: A mixed methods approach.

Abstract: We sought to understand how health coaches affect the work of primary care clinicians and influence their perception of patient care. As a mixed methods hypothesis-generating study, we administered a structured post-visit survey and conducted in-depth individual interviews with primary care clinicians who worked with health coaches at two urban community health centers. Survey responses were compared using t tests. Interviews were transcribed and analyzed using Atlas.ti software and modified grounded theory. Surveys were completed by 15 of 17 clinicians for 61% of eligible patient visits (269/441). Compared to usual care patients, clinicians rated visits with health-coached patients as less demanding (2.44 vs. 3.06, p < .001) and were more likely to feel that they had adequate time with their patient (3.96 vs. 3.57, p < .001). Qualitative findings expanded upon these results and uncovered four key health coach activities thought to improve patient care. Through developing a rapport with patients over time and working with patients between medical visits, health coaches (a) empower patients by offering self-management support, (b) bridge communication gaps between clinicians and patients, (c) assist patients in navigating the health care system, and (d) act as a point of contact for patients.

Major lessons learned from a nationally-based community-academic partnership: addressing sibling adjustment to childhood cancer.

Abstract: Prolonged, intensive treatment protocols for childhood cancer disrupt family routines and daily functioning, with effects extending to all family members. Despite their unique needs, siblings of children with cancer receive limited attention from community organizations and researchers. Community-academic partnerships may foster research that effectively assesses and addresses siblings' unmet needs. In this article, "community" refers to siblings of children with cancer who participate in SuperSibs!, a national nonprofit organization for siblings of children with cancer. This article (a) describes a replicable model for successful community-academic partnerships: the Sibling Research Advisory Board (SRAB) and (b) articulates "lessons learned" from this partnership, including documenting the ability to recruit a representative sample through a community organization. Lessons emerged from an iterative process of discussion and revision that involved all SRAB members. This case study describes approaches to overcoming practical obstacles in community-partnered research planning and implementation. To meet the common goals of identifying and addressing unmet sibling needs, SRAB partners learned to establish a common language, identify each team member's unique expertise, and acknowledge differences in approach (e.g., methodology, pace of accomplishment) between research and community service. SRAB's ability to recruit a representative sample was achieved through close collaboration with SuperSibs! and implementation of active recruitment strategies to overcome barriers to research participation. Protection of community member privacy was emphasized alongside methodological rigor. Community-academic partnerships enable research with high-need, hard-to-access populations. Proactively identifying and addressing common pitfalls of community-academic partnerships promotes community engagement and acceptability and facilitates high-quality research.