Showing papers in "Families, Systems, & Health in 2017"

Parental perspectives of screening for adverse childhood experiences in pediatric primary care.

Abstract: INTRODUCTION Pediatricians recognize a need to mitigate the negative impact that adverse childhood experiences (ACEs) can have on health and development. However, ACEs screening and interventions in primary care pediatrics may be inhibited by concerns about parental perceptions. We assessed parent perspectives of screening for ACEs in the pediatric primary care setting, to understand their views on the potential impact of their ACEs on their parenting and to identify opportunities for pediatric anticipatory guidance. METHOD We used purposive sampling to recruit parents of children <6 years receiving care at an urban, pediatric clinic. Semistructured questions guided 1:1 interviews that were later coded by multiple researchers to verify reliability. A thematic framework approach guided analysis and identified main themes and subthemes. RESULTS We reached thematic saturation after 15 parent interviews, which consistently revealed 3 interrelated themes. First, parents strongly supported ACEs screening as a bridge to needed services, and they recommended using a trauma-sensitive, person-centered approach in pediatric practices. Second, parents understood the intergenerational impact of ACEs and expressed a desire to break the cycle of adversity. Finally, parents saw their child's pediatrician as a potential change-agent who could provide support to meet their parenting goals. DISCUSSION Parents want to discuss their ACEs and receive help and guidance from pediatricians. Furthermore, they perceive their child's pediatrician as having an important role to play in meeting their parenting goals. It is important to ensure that pediatricians have the training, skills and familiarity with available resources to meet parental expectations. (PsycINFO Database Record

Family members' experiences supporting adults with chronic illness: A national survey.

Abstract: Introduction Family and friends often help chronically ill adults manage their conditions. Information about specific ways supporters help with disease management, and their experiences with and concerns about helping are lacking. This study describes key roles and concerns of family members who support the health management of adults with chronic illness, and compares experiences of health supporters living in and outside of support recipients' homes. Methods Data were obtained from a national internet survey of 1,722 adults selected to represent the U.S. Population Detailed survey questions were completed by 703 respondents who reported providing regular disease-management help to at least one functionally-independent family member or friend with at least one of five chronic conditions (diabetes, heart failure, chronic lung disease, arthritis, depression). Results Current supporters assisted 834 chronically ill adults: 257 receiving in-home support and 577 receiving out-of-home support. Current supporters spent 2.1 hours/week on average helping their support recipient with health care, and 21.2% attended their recipient's health care appointments. Many recipients discussed crucial concerns about medication side effects (47.0%) and trouble paying for medications (32.0%) with supporters. However, 41.0% of supporters reported insufficient information about recipients' health conditions and regimen to be helpful. In-home supporters reported arguing more often with support recipients, but also received more information from recipients' health care providers than out-of-home supporters. Discussion Family and friends have significant potential to influence patients' chronic illness self-management. Programs to engage chronically ill patients' families to support self-management could provide information and skills targeting needs identified by supporters. (PsycINFO Database Record

Moving effective treatment for posttraumatic stress disorder to primary care: A randomized controlled trial with active duty military.

Abstract: Introduction Many military service members with PTSD do not receive evidence-based specialty behavioral health treatment because of perceived barriers and stigma. Behavioral health providers in primary care can deliver brief, effective treatments expanding access and reducing barriers and stigma. The purpose of this randomized clinical trial was to determine if a brief cognitive-behavior therapy delivered in primary care using the Primary Care Behavioral Health model would be effective at reducing PTSD and co-occurring symptoms. Method A total of 67 service members (50 men, 17 women) were randomized to receive a brief, trauma-focused intervention developed for the primary care setting called Prolonged Exposure for Primary Care (PE-PC) or a delayed treatment minimal contact control condition. Inclusion criteria were significant PTSD symptoms following military deployment, medication stability, and interest in receiving treatment for PTSD symptoms in primary care. Exclusion criteria were moderate or greater risk of suicide, severe brain injury, or alcohol/substance use at a level that required immediate treatment. Assessments were completed at baseline, posttreatment/postminimal contact control, and at 8-week and 6-month posttreatment follow-up points. Primary measures were the PTSD Symptom Scale-Interview and the PTSD Checklist-Stressor-Specific. Results PE-PC resulted in larger reduction in PTSD severity and general distress than the minimal contact control. Delayed treatment evidenced medium to large effects comparable to the immediate intervention group. Treatment benefits persisted through the 6-month follow-up of the study. Discussion PE-PC delivered in integrated primary care is effective for the treatment of PTSD and co-occurring symptoms and may help reduce barriers and stigma found in specialty care settings. (PsycINFO Database Record

Reducing barriers to mental health care for student-athletes: An integrated care model.

Abstract: Research suggests that National Collegiate Athletic Association (NCAA) Division I student-athletes have higher levels of stress and other behavioral health issues, including substance use, than nonathletes. For several reasons, student-athletes may be less likely to admit to behavioral health issues and seek mental health care. Integrated care is a model of care that integrates behavioral health into a medical practice. This article explores the newly released NCAA Best Mental Health Practice guidelines and the application of integrated care to a Division I athletic training room setting using the three-worldview framework for successful integration, incorporating clinical outcomes, operational reliability, and financial stability. (PsycINFO Database Record

Promoting Resilience in Stress Management for Parents (PRISM-P): An intervention for caregivers of youth with serious illness.

Abstract: Introduction It is well-known that parental stress and coping impacts the well-being of children with serious illness The current study aimed to evaluate the feasibility and satisfaction of a novel resilience promoting intervention, the Promoting Resilience in Stress Management Intervention for Parents (PRISM-P) among parents of adolescents and young adults with Type 1 diabetes or cancer Secondary analyses explored the effect of the PRISM-P on parent-reported resilience and distress Method The PRISM-P includes 4 short skills-based modules, delivered in either 2 or 4 separate, individual sessions English-speaking parents of adolescents with cancer or Type 1 diabetes were eligible Feasibility was conservatively defined as a completion rate of 80%; satisfaction was qualitatively evaluated based upon parent feedback regarding intervention content, timing, and format Resilience and distress were assessed pre- and postintervention with the Connor Davidson Resilience Scale and the Kessler-6 Psychological Distress Scale Results Twelve of 24 caregivers of youth with diabetes (50%) and 13 of 15 caregivers of youth with cancer (87%) agreed to participate Nine of 12 (75%) and 9 of 13 (64%) completed all PRISM-P modules, respectively Among those who completed the intervention, qualitative satisfaction was high Parent-reported resilience and distress scores improved after the intervention Effect sizes for both groups indicated a moderate intervention effect Discussion Ultimately, the PRISM-P intervention was well accepted and impactful among parents who completed it However, attrition rates were higher than anticipated, suggesting alternative or less time-intensive formats may be more feasible (PsycINFO Database Record

Community health workers in diabetes care: A systematic review of randomized controlled trials.

Abstract: Introduction Maintaining optimal self-care in managing Type 2 diabetes is a common struggle for patients due to several barriers, including access to quality services, financial insecurity and/or lack of insurance, and emotional distress. Consequently, morbidity and mortality rates are high, alongside rising health care costs. Alternative approaches that address common barriers require further investigation. This systematic review of randomized controlled trials examines the effectiveness of using community health workers (CHWs) in Type 2 diabetes care. This effort is warranted to orient practitioners and researchers to the state of existing knowledge, and to direct clinical practice and future research. Method Data were extracted from 17 peer-reviewed articles; they were examined with respect to theory integration, CHW intervention design, outcome variables, and findings. Results Approximately one-third of articles explicitly integrated theory into their research conceptualization and design. There was great variation across intervention dosages, attrition rates, and methods of CHW training. Main foci across studies' findings suggest that a CHW intervention has significant impacts on physical health outcomes, diabetes knowledge, self-care behaviors, and emotional distress and well-being. Discussion Principal implications relate to the need for more research regarding CHW intervention types and methods, and further investigation about the mechanisms of change within a CHW-delivered intervention. Findings support the case for more CHWs in treatment teams to bridge patients with the medical system. This research will serve to better equip providers in the support of patients managing Type 2 diabetes and advance the Triple Aim of health care. (PsycINFO Database Record

Adverse childhood experiences: Screening and health in children from birth to age 5.

Abstract: Introduction Adverse childhood experiences (ACEs) have lifetime consequences for health and development. This study examined whether there is evidence to support a screening approach that assesses children's current exposures to risks that act as proxies for ACEs, measured in a way that falls below a threshold of explicit abuse, neglect, or illegal behavior. Method We used data collected during routine home visitations of at-risk children aged 0-5. Home visitors used the Family Map Inventories (FMI; Whiteside-Mansell et al., 2007) to screen ACEs and measure health outcomes, and the Ages and Stages Questionnaire (3rd ed.; ASQ-3; Squires, Twombly, Bricker, & Potter, 2009) to screen child development. Parents (N = 2,004) were 28 years of age on average and most were White (60%). Children were 32 months of age on average and equally divided on gender (51% male). Results Children were exposed at rates of 27%, 17%, 11%, and 11% to 1, 2, 3, and 4 or more FMI-ACEs, respectively. Logistic regressions revealed significant associations between FMI-ACE scores and health environments and outcomes for children, including health risks in the home (e.g., safety and secondhand smoke exposure), underuse of preventive health care, and overuse of emergency medical treatment. In terms of development, having four or more FMI-ACEs was associated with the child having a chronic health condition and screening at risk for delay in at least one area of development. Discussion Findings highlight the potential use of questionnaires and in-home observations to measure and intervene in potentially developing ACEs. Further, our screening was associated with children whose health was at risk very early in development. (PsycINFO Database Record

Parenting behaviors and the well-being of children with a chronic physical condition.

Abstract: Introduction Numerous studies have identified the importance of parenting behaviors to the well-being of children with chronic physical conditions. Synthesizing the findings of these studies has potential to identify which parenting behaviors are associated with specific aspects of child well-being. Method We retrieved research reports addressing the relationship between parenting behaviors and well-being in children with chronic physical conditions, and categorized parenting behaviors based on Skinner, Johnson, and Snyder's (2005) core dimensions of parenting (warmth, rejection, structure, chaos, autonomy support, and coercion) Through meta-analysis, we examined relationships between parenting dimension and child well-being variables. Results Fifty-four reports from 47 unique studies met inclusion criteria. Parent warmth was associated with less child depression, better quality of life, better physical functioning, and fewer externalizing behavior problems. Parent rejection was associated with more child depression, internalizing/externalizing behavior problems, and poorer physical functioning. Parent structure was associated with better child physical functioning. Parent chaos was associated with poorer child physical functioning. Parent autonomy support was associated with better quality of life and fewer externalizing behavior problems. Parent coercion was associated with more child depression, poorer quality of life, poorer physical function, and more internalizing behavior problems. Conclusion The results identify multiple, potentially modifiable parenting dimensions associated with well-being in children with a chronic condition, which could be targeted in developing family-focused interventions. They also provide evidence that research using Skinner's core dimensions could lead to conceptualization and study of parenting behaviors in ways that would enable comparison of parenting in a variety of health and sociocultural contexts. (PsycINFO Database Record

Collaborative mental health care for pediatric behavior disorders in primary care: Does it reduce mental health care costs?

Abstract: Overview One recently completed randomized controlled trial (RCT) demonstrated the effectiveness of a doctor-office collaborative care (DOCC), relative to enhanced usual care (EUC), for pediatric behavior problems and attention-deficit/hyperactivity disorder. In this study, we sought to extend the literature by incorporating a cost-analysis component at the conclusion of the aforementioned trial. To our knowledge, it was the first study to examine whether the DOCC model leads to lower costs of mental health services for children. Method Financial records from the RCT provided cost information about all the 321 child study participants in the 6-month intervention period, and claims data from insurance plans provided cost information about community mental health services for 57 children, whose parents consented to release their claims data, in both pre- and postintervention periods. Both descriptive and multivariate analyses were performed. Results The DOCC group had higher intervention costs, but the cost per patient treated in the DOCC group was lower than the EUC group during the 6-month intervention period. In terms of costs of community mental health services, although the 2 groups had similar costs in the 6 months before the RCT intervention, the DOCC group had significantly lower costs during the 6-month intervention period and 6 or 12 months after the intervention, but not in the 18 or 24 months after the intervention. Discussion The DOCC model has the potential for cost savings during the intervention period and the follow-up periods immediately after the intervention while improving clinical effectiveness. (PsycINFO Database Record

Patient-perceived family stigma of type 2 diabetes and its consequences.

Abstract: INTRODUCTION Adults with type two diabetes (T2D) report being monitored and judged by family members, contributing to feelings of guilt/shame, and attempts to conceal one's diabetes status or self-care efforts. However, studies have not yet quantitatively examined T2D stigma from family members. Our objective was to assess the frequency of T2D family stigma and its association with helpful and harmful diabetes-specific family behaviors and psychological and behavioral consequences of stigma. METHOD A sample of predominantly African-American adults with T2D and low income completed items written for this study to assess T2D family stigma and consequences of stigma. We explored frequencies and bivariate correlations between these constructs and diabetes-specific family behaviors (measured with the Diabetes Family Behavior Checklist-II). RESULTS Participants (N = 53) were 57.3 ± 8.7 years old, 70% African American, 96% had annual incomes <$20K, and average HbA1C was 8.0 ± 2.2%. More than half (57%) reported at least 1 experience of family stigma (1.26 ± 1.8 of 9 queried, α = .84), and 28% reported at least 1 consequence (0.6 ± 1.3 of 5 queried, α = .87). Reporting more family stigma was associated with more consequences (ρ = .52, p < .001) but not with helpful or harmful family behaviors. DISCUSSION Perceptions/experiences of T2D-related family stigma were common in our sample and associated with consequences of stigma including concealment and resentment of self-care, which may affect clinical outcomes. (PsycINFO Database Record

Couples coping with cardiovascular disease: A systematic review.

Abstract: INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death for both men and women. Its potential ramifications on all aspects of life, for patients and partners, are just beginning to be understood. Although research has focused on the individual who has received the diagnosis, relatively little is known about how couples manage CVD. This article presents a systematic review of literature that focuses on how couples cope with one partner's CVD diagnosis. A systematic review is warranted to orient practitioners, policy makers, and researchers to the state of existing knowledge and its gaps and to identify what still needs to be done. METHOD Data were extracted from 25 peer-reviewed articles that met our inclusion criteria. Content examined included theory integration, coping constructs and instruments, samples, analyses, and findings. RESULTS Most articles successfully integrated theory in the studies' respective conceptualizations and designs. Most used valid and reliable instruments to measure coping. Principal limitations included problematic sampling strategies and analysis techniques, thereby limiting external validity. DISCUSSION Principal implications of this review's findings relate to our fields' need to provide more care focused on dyads (vs. individual patients), adopt an integrated model in health care, and conduct systemic, longitudinal research to gain a better grasp on how coping changes over time. Doing so will serve to better equip providers in the support of patients and partners living with CVD. (PsycINFO Database Record

Understanding integrated mental health care in "real-world" primary care settings: What matters to health care providers and clients for evaluation and improvement?

Abstract: PURPOSE The integration of mental health specialists into primary care has been widely advocated to deliver evidence-based mental health care to a defined population while improving access, clinical outcomes, and cost efficiency. Integrated care has been infrequently and inconsistently translated into real-world settings; as a result, the key individual components of effective integrated care remain unclear. METHOD This article reports findings from a qualitative study that explored provider and client experiences of integrated care. We conducted in-depth interviews with integrated care providers (n = 13) and clients (n = 9) to understand their perspectives and experiences of integrated care including recommended areas for quality measurement and improvement. The authors used qualitative content and reflexive thematic analytic approaches to synthesize the interview data. RESULTS Clients and integrated care providers agreed regarding the overarching concepts of the what, how, and why of integrated care including co-location of care; continuity of care; team composition and functioning; client centeredness; and comprehensive care for individuals and populations. Providers and clients proposed a number of dimensions that could be the focus for quality measurement and evaluation, illuminating what is needed for successful context-sensitive spreading and scaling of integrated care interventions. CONCLUSION With a mounting gap between the empirical support for integrated care approaches and the implementation of these models, there is a need to clarify the aims of integrated care and the key ingredients required for widespread implementation outside of research settings. This study has important implications for future integrated care research, and health care provider and client engagement in the quality movement. (PsycINFO Database Record

Implementation of behavioral health interventions in real world scenarios: Managing complex change

Abstract: Introduction A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care. Method Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach. Results The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration. Discussion This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record

Integrated care clinic: Creating enhanced clinical pathways for integrated behavioral health care in a family medicine residency clinic serving a low-income, minority population.

Abstract: Introduction Research examining the implementation and effectiveness of integrated behavioral health (BH) care in family medicine/primary care is growing. However, research identifying ways to consistently use integrated BH in busy family medicine/primary care settings with underserved populations is limited. This study describes 1 family medicine clinic's transformation into a fully integrated BH care clinic through the development of an Integrated Care Clinic (ICC) and enhanced clinical pathways to promote regular use of behavioral health clinicians (BHCs). Method We implemented the ICC at the Broadway Family Medicine Clinic serving a low-income ( 70% African American) in Minnesota. We conducted a pre- and postevaluation of the ICC during regular clinic activity. Results Pilot findings indicated that the creation of ICC and the use of enhanced clinical pathways (e.g., 5-2-1-0 obesity prevention messages, Transitional Care Management, postpartum depression screening visits, warm hand-offs) to facilitate regular use of integrated BH care resulted in 6 integrated care visits per BHC per clinic half-day. In addition, changes in the behavioral/mental health therapy appointment time slot (from 60 to 30 min) reduced therapy no-show rates. Transitional Care Management (TCM) visits also showed improved pre- and postchanges in patient and clinician satisfaction and reductions in patient hospital readmission rates. Discussion The transformation into a fully integrated BH family medicine clinic through the creation of ICC and enhanced clinical pathways to facilitate regular integrated BH care showed promising pilot results. Future research is needed to examine associations between ICC and patient outcomes (e.g., weight, depressive symptoms). (PsycINFO Database Record

Applying a family systems lens to proxy decision making in clinical practice and research.

Abstract: When patients are incapacitated and face serious illness, family members must make medical decisions for the patient. Medical decision sciences give only modest attention to the relationships among patients and their family members, including impact that these relationships have on the decision-making process. A review of the literature reveals little effort to systematically apply a theoretical framework to the role of family interactions in proxy decision making. A family systems perspective can provide a useful lens through which to understand the dynamics of proxy decision making. This article considers the mutual impact of family systems on the processes and outcomes of proxy decision making. The article first reviews medical decision science's evolution and focus on proxy decision making and then reviews a family systems approach, giving particular attention to Rolland's Family Systems Illness Model. A case illustrates how clinical practice and how research would benefit from bringing family systems thinking to proxy decisions. We recommend including a family systems approach in medical decision science research and clinical practices around proxy decisions making. We propose that clinical decisions could be less conflicted and less emotionally troubling for families and clinicians if family systems approaches were included. This perspective opens new directions for research and novel approaches to clinical care. (PsycINFO Database Record

A systematic review of evaluation research in integrated behavioral health care: Operational and financial characteristics.

Abstract: Introduction Integrated behavioral health care (IBHC) is an emerging solution for the delivery of behavioral health in primary care contexts. Although IBHC has been implemented and studied for more than 2 decades, little seems to be known about how it is best evaluated. This article illustrates a framework for IBHC evaluation based on the Three World view (with a focus on the operational and financial worlds) and delivers results from a systematic review on the operational and financial characteristics of existing IBHC research. Method This study identified original reports of research that included an evaluation or assessment of the operational or financial success or sustainability of IBHC sites or programs. Results A total of 3,386 articles were found through the selected databases and 46 articles were found to meet the inclusion criteria. From the 46 articles that contained an IBHC evaluation including operational or financial variables, 9 operational and 11 financial characteristics were identified as barriers or strengths to sustainability or success. The characteristics of the evaluation participants, IBHC settings, and method of evaluation were also coded and analyzed. Discussion As a result of this systematic review of articles, evaluation of the success and sustainability of the operational and financial worlds can now be conceptualized at provider and practice levels. Collaboration and communication between medical and behavioral health providers was a significant operational characteristic related to success and sustainability. Financial characteristics indicated that continuous financial evaluation throughout implementation was important to success and sustainability. (PsycINFO Database Record

Using implementation science to guide the integration of evidence-based family interventions into primary care.

Abstract: This article is a demonstration of how an implementation-science (IS) framework can be coupled with the measurement of implementation outcomes to effectively integrate evidence-based family interventions in primary care. The primary care environment presents a number of challenges for successfully integrating such interventions. However, IS methods can improve the prospect of successfully implementing a new intervention while simultaneously and rigorously evaluating the impact on salient outcomes. We used our experiences across 2 pilot trials in which the family check-up (Smith, Montano, Mauricio, Berkel, & Dishion, 2016), an evidence-based family intervention, was integrated into primary care. In these pilot trials, the exploration, preparation, implementation, and sustainment (EPIS) framework and the Proctor et al. taxonomy of implementation outcomes were used to guide the implementation and evaluate its success. Grounding our presentation in our pilot work offers an illustration of applying the EPIS framework and outcomes measurement to real-world problems and contexts. When embarking on new efforts to integrate behavioral interventions into health-care settings, the application of IS frameworks and measurement strategies can create generalizable knowledge that substantively contributes to a sparse literature. Today, those "in the trenches" who are translating evidence-based interventions to their setting can contribute to the corpus of research in integrated care by using IS methods to plan a new program and evaluate its feasibility, adoption, and reach. (PsycINFO Database Record

Integrated behavioral health practice facilitation in patient centered medical homes: A promising application

Abstract: INTRODUCTION The purpose of this study was to assess the degree of behavioral health (BH) integration change in patient-centered medical homes (PCMHs) when using a practice facilitator (PF) specially trained in implementing integrated care and how a quasi-experimental design assists in this process. METHOD Twelve PCMHs, 8 Federally Qualified Health Centers and 4 private practices, with varying degrees of BH services participated in this study. The degree of BH integration was assessed with a quasi-experimental design using the Maine Health Access Foundation's Site Self Assessment (MeHAF SSA) at baseline and after implementing site-specific BH services. The sites tracked completion of unique objectively measured goals being implemented using the Goal Attainment Scale (GAS) score. RESULTS At the conclusion of the study, sites saw a statistically significant increase in the level of BH integration from a baseline of 2.73 (SD = 0.44) to a postintervention score of 3.49 (SD = 0.22) with improvements from mild-moderate overall integration to moderate-advanced overall integration (p < .001). In addition, 10 out of the 12 sites achieved successful implementation of unique goals with assistance from the PF. DISCUSSION This study provides the first quasi-experimental/pretest-posttest evidence utilizing real-world data that the practice facilitation method is an effective solution toward increasing the degree of BH integration. This paper describes the real-world efforts to evaluate the degree of BH integration change in PCMHs when using a PF with content expertise in BH integration within primary care. (PsycINFO Database Record

Significant others' weight-related comments and their associations with weight-control behavior, muscle-enhancing behavior, and emotional well-being.

Abstract: INTRODUCTION This large mixed-method study examines the prevalence of reported positive and negative weight-related comments from significant others and ways in which they are associated with weight-control and muscle-enhancing behaviors and emotional well-being in young adults. METHOD As part of Project EAT (Eating and Activity in Teens and Young Adults)-IV, survey data were provided by 1,436 young adult men and women with a significant other in 2015-2016 (mean age = 31.1 years; 58.6% women). Independent variables included the reported frequency of receiving positive or negative comments about body shape or size; written examples of positive comments were qualitatively coded for subtypes. Analysis of covariance, adjusting for body mass index, tested associations between comments and weight-control behaviors, muscle-enhancing behaviors, and various measures of emotional well-being (i.e., body satisfaction, self-esteem, and depressive symptoms). RESULTS About twice as many participants received positive comments from their significant others compared to negative comments (75% vs. 36%). Receiving positive and/or negative comments was related to body satisfaction, self-esteem, and depressive symptoms but was largely unrelated to weight-control and muscle-enhancing behaviors. In almost all cases, receiving no comments was associated with significantly better well-being than was receiving only negative comments. There were few differences in weight-control or muscle-enhancing behaviors or emotional well-being across subtypes of positive comments. DISCUSSION Reporting the receipt of negative comments from significant others was associated with poorer emotional well-being than was receiving positive comments or no weight-related comments at all. Therapists and other health professionals working with couples should consider advising young adults on the apparent advantages of providing positive feedback regarding weight and shape or abstaining from commenting altogether. (PsycINFO Database Record

Narrative review of provider behavior in primary care behavioral health: How process data can inform quality improvement.

Abstract: Objective Primary care behavioral health (PCBH) is a population-based approach to delivering mental and behavioral health care in the primary care setting. Implementation of the PCBH model varies across practice settings, which can impact how PCBH providers deliver services to patients and in turn may predict a variety of important outcomes. This article aims to characterize PCBH provider engagement in key processes of integrated care as demonstrated in results from empirical studies of real-world clinical practice. Method For this narrative review of published studies on PCBH provider engagement in processes of care, PubMed and PsycINFO databases were searched from January 1990 through May 2016 to identify relevant articles. Results Provider adherence to the brief, time-limited treatment model appears suboptimal. Common mental health conditions, such as depression, were often the primary focus of provider attention, with less consistent emphasis on behavioral medicine concerns. Whereas providers regularly conducted qualitative functional assessments with patients, routine use of standardized measures was low. Engagement in interprofessional collaboration with the primary care team was also low, but engagement in behaviors that fostered therapeutic relationships was high. Discussion This review identified several strengths and weaknesses of typical PCBH provider practices. Results are discussed in relation to their value as areas for future quality improvement initiatives that can improve PCBH service delivery and, ultimately, patient outcomes. (PsycINFO Database Record

Where's the LGBT in integrated care research? A systematic review.

Abstract: INTRODUCTION Lesbian, gay, bisexual, and transgender (LGBT) individuals experience more negative health outcomes compared with their heterosexual peers. The health disparities are often related to family and social rejection of the LGBT individuals. Integrated care, and Medical Family Therapy in particular, may aid in addressing the systemic nature of the negative health outcomes. METHOD To better understand the current state of the integrated care literature on addressing the health needs of LGBT individuals, a systematic review of the research literature was conducted from January 2000 to January 2016 for articles including integrated health care interventions for LGBT populations. Independent reviewers coded identified articles. RESULTS Only 8 research articles met criteria for inclusion out of the 2,553 initially identified articles in the search. Results indicated a lack of integrated care research on health care and health needs of LGBT individuals, and none of the articles addressed the use of family or systemic-level interventions. DISCUSSION Implications for future research and the need for better education training are discussed. (PsycINFO Database Record

Need, access, and the reach of integrated care: A typology of patients.

Abstract: INTRODUCTION This paper is a report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also described the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). METHOD A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. RESULTS Hierarchical and k-means cluster analyses revealed 3 groups: (a) Well-Served patients, characterized by high perceived need for services, high service use, and low barriers to service use (40%); (b) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (c) Subclinical patients, characterized by low perceived need, low service use, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. DISCUSSION We found primary care patients could be grouped into 3 categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health (MH) settings. IBHC may be a promising approach for extending the reach of MH care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service-delivery model. (PsycINFO Database Record

Family functioning and child asthma severity: A bio-behavioral approach.

Abstract: Introduction Family factors are directly associated with the psychosocial adjustment of children with chronic illnesses such as asthma (Kaugars, Klinnert, & Bender, 2004). Research indicates that negative family factors may also contribute to child disease severity via bio-behavioral mechanisms of effect. For instance, children from more conflicted families often experience greater internalizing symptoms that subsequently impact their asthma severity (Wood et al., 2006). These pathways have yet to be examined with a comprehensive focus on strength-based family factors. This study examined whether factors such as family cohesion, problem-solving abilities, and communication influence asthma severity via their effects on child depression and anxiety symptoms. Method Participants were 215 children (136 males and 79 females), ages 5 to 12 years old, and their families. Primary caregiver, child, and teacher ratings of child and family functioning in addition to objective measures of parent-child interactions and asthma severity were collected. Results Using structural equation modeling, the authors identified significant indirect associations between family factors and child asthma severity via child depressive symptoms; however, these associations were not present in models with child anxiety symptoms. Discussion Results suggest an indirect effect of family functioning on children's lung function, with differential roles of anxiety and depression in these pathways. This article also highlights the importance of incorporating multirater multimethod measures to understand children's experiences in pediatric asthma. (PsycINFO Database Record

How to write a health policy brief.

Abstract: Although many health care professionals are interested in health policy, relatively few have training in how to utilize their clinical experience and scientific knowledge to impact policy. Developing a policy brief is one approach that health professionals may use to draw attention to important evidence that relates to policy. This article offers guidance on how to write a policy brief by outlining 4 steps: (a) define the problem, (b) state the policy, (c) make your case, and (d) discuss the impact. The steps and tips offer a starting point for health care professionals interested in health policy and translating research or clinical experience to impact policy. (PsycINFO Database Record

Exploring attrition, fidelity, and effectiveness of wraparound services among low-income youth of different racial backgrounds.

Abstract: INTRODUCTION Wraparound services (i.e., community-based collaborative care) for children with severe mental health needs have been reported as effective. Yet, no attention has been given to aggregating treatment results across racially and economically diverse groups of youth. While controlling for socioeconomic status (i.e., free/reduced lunch status) this study explored potential racial disparities in response to wraparound services. METHOD Data from a diverse statewide sample (N = 1,006) of low-income youth (ages 6-18 years) identified as having a serious emotional disturbance were analyzed for differences in wraparound attrition, fidelity, and effectiveness. RESULTS African American youth receiving free/reduced lunch failed to complete wraparound services at significantly higher rates when compared to Caucasian youth. For those who met treatment goals (i.e., completed services), mean intervention fidelity scores showed services to be implemented similarly across youth. Furthermore, wraparound services resulted in improvements in mental health functioning, though racial background and attrition status impacted exit scores. DISCUSSION Collaborative community-based mental health services improve youth outcomes and physicians and school personnel should strive to be part of these teams. Further research is needed to more closely examine the challenges of helping youth to meet the goals associated with their wraparound services. Relatively higher service attrition rates in low-income African American youth warrants further investigation. (PsycINFO Database Record

"Take your time, then follow your heart:" Previvors' advice for communicating about family planning after testing positive for a BRCA genetic variant

Abstract: Introduction The purpose of this study was to identify previvors' strategies for communicating about family planning after testing positive for a variant of the "breast cancer gene" (BRCA). Method Semistructured interviews were conducted with 20 women currently in committed romantic relationships, but who had not yet completed family planning upon finding out about their BRCA mutation status. Results Data analysis produced three categories of participant advice given to newly diagnosed previvors. Participants advised the following: (a) the importance of engaging in two-way dialogue with their partners/spouses across the life span of the partnership, (b) seeking information on new technologies and information regarding family-planning and genetic-cancer-prevention decision-making, as well as recognizing where to go for different support needs, and (c) managing and acknowledging emotions surrounding their BRCA-related health decisions. Discussion Previvors who have already had family-planning and genetic-cancer-risk conversations had important advice for newly diagnosed previvors. Practical advice for starting and managing conversations with partners/spouses, family members, and friends are discussed. (PsycINFO Database Record

Identifying trajectories of change to improve understanding of integrated health care outcomes on PTSD symptoms post disaster

Abstract: INTRODUCTION Addressing life stressors is an important function for integrated care, especially for health care homes located in disaster prone environments. This study evaluated trajectories of change for patients with postdisaster posttraumatic stress disorder (PTSD) who were seen in integrated care. In addition to describing the results, this article provides the methods of subgroup analyses as this may be useful for others working in real-world practice. METHOD Patients (N = 340) receiving services at 5 rural health clinics self-reported PTSD symptoms as part of an ongoing evaluation to study the effectiveness of integrated health. Analysis of variance was used to assess differences overtime and trajectories were identified with cluster analyses. Disaster and trauma related factors associated with these trajectories were assessed using logistic regression. RESULTS Significant overall decreases in PTSD symptoms overtime were found; individual trajectories were identified and include stable low, steep declines, stable high symptoms, and increasing symptoms. Stress related to disaster and the number of other traumas patients experienced correctly classified trajectory membership. DISCUSSION Trajectories indicate that patients have differing treatment needs and cluster analysis as an evaluation technique may be useful in identifying what treatment works and for whom. The present study addresses a major concern for health care providers serving disaster prone communities and emphasizes the importance of identifying pre incident and disaster related risk vulnerabilities that contribute to mental health outcomes. Subgroup analyses are a useful tool for developing more targeted treatment within integrated care and may be an accessible research strategy for others working in such settings. (PsycINFO Database Record

Group education sessions for women veterans who experienced sexual violence: Qualitative findings.

Abstract: Introduction The impact of sexual violence (SV) on mental health, self-care, and interpersonal relationships is profound and poses special challenges to health care delivery. Reproductive health care merits special attention because the care required may be linked to reminders of past abuse. We explored facilitators and barriers affecting the use of reproductive health services among women veterans with a history of SV. Method Between June and September 2015, we conducted 2 focus groups and 3 general education sessions with 27 female veterans with a history of SV at 1 medical center. We analyzed transcripts according to applied thematic analysis and used Nvivo software for data management and retrieval. Results Three main themes emerged from the focus groups and education sessions. Participants (a) expressed a desire for greater agency in relation to the control they have over their bodies and medical care; (b) described how posttraumatic stress symptoms are retriggered during medical care; and (c) expressed needs for additional education, peer and provider support within the medical system. Discussion For women with a history of SV, multiple individual and systemic barriers complicate how they utilize reproductive health services. Group education sessions were an effective mode of support, information and connection to other women within the Veterans Health Administration. (PsycINFO Database Record

Development and implementation of a psychotherapy tracking database in primary care.

Abstract: INTRODUCTION Although there is a rapid increase in the integration of behavioral health services in primary care, few studies have evaluated the effectiveness of these services in real-world clinical settings, in part due to the difficulty of translating traditional mental health research designs to this setting. Accordingly, innovative approaches are needed to fit the unique challenges of conducting research in primary care. The development and implementation of one such approach is described in this article. METHOD A continuously populating database for psychotherapy services was implemented across 5 primary care clinics in a large health system to assess several levels of patient care, including service utilization, symptomatic outcomes, and session-by-session use of psychotherapy principles by providers. RESULTS Each phase of implementation revealed challenges, including clinician time, dissemination to clinics with different resources, and fidelity of data collection strategy across providers, as well as benefits, including the generation of useful data to inform clinical care, program development, and empirical research. DISCUSSION The feasible and sustainable implementation of data collection for routine clinical practice in primary care has the potential to fuel the evidence base around integrated care. The current project describes the development of an innovative approach that, with further empirical study and refinement, could enable health care professionals and systems to understand their population and clinical process in a way that addresses essential gaps in the integrated care literature. (PsycINFO Database Record

Mixed methods evaluation of a collaborative care implementation using RE-AIM.

Abstract: INTRODUCTION Application of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework using mixed methods to evaluate a collaborative care practice implementation can inform the literature on real-world collaborative care experiences. METHOD Two primary care practices serving Niagara Falls, NY, implemented collaborative care. Adults age 18 and over were screened at least annually for depression, anxiety, and alcohol use using the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder questionnaire (GAD-7), and the AUDIT alcohol consumption questionnaire (AUDIT-C). Primary care clinicians referred patients screening positive to the on-site behavioral health care manager (BHCM) with warm handoffs; the BHCM used a mixed therapeutic approach, initiated consultations with a psychiatrist and a community resource liaison as needed, in collaboration with the clinician. External evaluators used mixed methods to assess collaborative care services' RE-AIM. RESULTS Nearly 40% of patients screened positive for at least one behavioral healthcare (BH) concern or were referred to BH services upon clinician judgment. Of these patients, 43% were referred to integrated BH services, of whom 86% accepted and 54% actually participated in services. There were no differences in changes in symptoms between those who did and did not participate in services. Patients reported the services were valuable and helped build skills for coping with complex health conditions and psychosocial issues. DISCUSSION Evaluation of collaborative care using the RE-AIM framework may help others systematically evaluate programs, identify local improvement opportunities, and contribute to the broad literature on integrated care dissemination and implementation. (PsycINFO Database Record