Showing papers in "Families, Systems, & Health in 2018"

A service user co-facilitated intervention to reduce mental illness stigma among primary healthcare workers: Utilizing perspectives of family members and caregivers.

Abstract: Introduction Service users' involvement as cofacilitators of mental health trainings is a nascent endeavor in low- and middle-income countries, and the role of families on service user participation in trainings has received limited attention. This study examined how caregivers perceive and facilitate service user's involvement in an antistigma program that was added to mental health Gap Action Program (mhGAP) trainings for primary care workers in Nepal. Method Service users were trained as cofacilitators for antistigma and mhGAP trainings delivered to primary care workers through the REducing Stigma among HealthcAre ProvidErs (RESHAPE) program. Key informant interviews (n = 17) were conducted with caregivers and service users in RESHAPE. Results Five themes emerged: (a) Caregivers' perceived benefits of service user involvement included reduced caregiver burden, learning new skills, and opportunities to develop support groups. (b) Caregivers' fear of worsening stigma impeded RESHAPE participation. (c) Lack of trust between caregivers and service users jeopardized participation, but it could be mitigated through family engagement with health workers. (d) Orientation provided to caregivers regarding RESHAPE needed greater attention, and when information was provided, it contributed to stigma reduction in families. (e) Time management impacted caregivers' ability to facilitate service user participation. Discussion Engagement with families allows for greater identification of motivational factors and barriers impacting optimal program performance. Caregiver involvement in all program elements should be considered best practice for service user-facilitated antistigma initiatives, and service users reluctant to include caregivers should be provided with health staff support to address barriers to including family. (PsycINFO Database Record

Suicide interventions in primary care: A selective review of the evidence.

Abstract: Introduction About half of people who die by suicide visit their primary care provider (PCP) within 1 month of doing so, compared with fewer than 1 in 5 contacting specialty mental health. Thus, primary care is an important setting for improving identification and treatment of suicide risk. This review identifies and summarizes evidence for the effectiveness of intervention components for suicide risk in primary care. Method We searched the PsycINFO database to identify relevant articles. We considered publications reporting the effectiveness of a packaged intervention for management of suicide risk in primary care or any other brief (i.e., single-session) intervention for suicide risk in the present review. Results Four major components to suicide interventions in primary care emerged: (a) educating practitioners, (b) screening for suicide risk and/or mood disturbance, (c) managing depression symptoms, and (d) assessing and managing suicide risk. Although practitioner education and screening for suicide risk are important, they are insufficient for effective suicide prevention programs. Collaborative treatment of depression by multidisciplinary teams can reduce rates of suicidal ideation in primary care patients. Recent evidence also indicates a single-session crisis response planning intervention may be effective at reducing suicidal ideation and attempts. Discussion Integration of behavioral health specialists trained in suicide risk assessment and management could be important for improving suicide prevention in primary care patients. This condensed review of the evidence serves as a resource for practitioners who are hoping to implement brief, effective interventions for suicide risk to better serve their patients. (PsycINFO Database Record

Family-based youth mental health interventions delivered by nonspecialist providers in low- and middle-income countries: A systematic review.

Abstract: Introduction Youth in low- and middle-income countries (LMICs) are at increased risk for poor mental health due to economic and social disadvantage. Interventions that strengthen families may equip children and adolescents with the supports and resources to fulfill their potential and buffer them from future stressors and adversity. Due to human resource constraints, task-sharing-delivery of interventions by nonspecialists-may be an effective strategy to facilitate the dissemination of mental health interventions in low resource contexts. To this end, we conducted a systematic review of the literature on family-based interventions delivered in LMICs by nonspecialist providers (NSPs) targeting youth mental health and family related outcomes. Method Cochrane and PRISMA procedures guided this review. Searches were conducted in PsychInfo, PubMed, and Web of Science, with additional articles pulled from reference lists. Results This search yielded 10 studies. Four studies were developed specifically for the delivery context using formative qualitative research; the remaining interventions underwent adaptation for use in the context. All interventions employed a period of structured training; nine studies additionally provided ongoing supervision to counselors. Interventions noted widespread acceptance of program material and delivery by NSPs. They also noted the need for ongoing supervision of NSPs to increase treatment fidelity. Discussion Usage of NSPs is quite consistently proving feasible, acceptable, and efficacious and is almost certainly a valuable component within approaches to scaling up mental health programs. A clear next step is to establish and evaluate sustainable models of training and supervision to further inform scalability. (PsycINFO Database Record

Caregiver health literacy predicting healthcare communication and system navigation difficulty.

Abstract: INTRODUCTION The role of caregiver health literacy in predicting difficulty communicating with health care professionals and navigating services and supports for older adults was examined and informed by the health literacy skills framework (Squiers, Peinade, Berkman, Boudewyns, & McCormack, 2012) METHOD Secondary analyses of cross-sectional data from the Pittsburgh Regional Caregivers Survey in 2017 were conducted A total of 761 caregivers of older adults reported communicating with health care providers and accessing services and supports Health care provider communication and navigation of services and supports (HCNS) was assessed through self-report questions on communication about needs of the care recipient and caregiver, and the ability to locate and arrange services and supports for the care recipient Health literacy was assessed with self-report questions on confidence filling out forms, need for help with reading information, and comprehension with written information A logistic regression was conducted to determine the relationship between health literacy and high HCNS difficulty while controlling for demographic and contextual caregiving characteristics RESULTS A fifth of the caregivers demonstrated low health literacy (n = 150, 197%) For a caregiver with low health literacy, the odds of having high levels of difficulty with HCNS was 252 times larger than the odds for a caregiver with adequate health literacy while controlling for demographic and contextual caregiving factors (odds ratio = 252, 95% confidence interval [157, 406]; p < 001) DISCUSSION Findings demonstrate that poor caregiver health literacy is an important factor associated with HCNS difficulty The health literacy of caregivers should be considered for assessments and interventions designed to identify and reduce the difficulty caregivers experience with HCNS (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Perceived child weight status, family structure and functioning, and support for health behaviors in a sample of bariatric surgery patients.

Abstract: INTRODUCTION The purpose of this study is to describe the associations between bariatric surgery patients' perspectives of their child's weight status, family support for eating and exercise behavior change, and family structure and functioning. METHOD A cross-sectional descriptive design with pre- and postsurgery (N = 224) patients was used. Demographics, perceptions of child weight status, family support for eating habits and exercise, and family functioning were assessed from patients at a University Bariatric Clinic. RESULTS Patients who perceived their child to be overweight/obese reported more impaired family functioning, less family exercise participation, and more discouragement for eating habit change in the family compared to patients who did not perceive their child to be overweight/obese. Single parents more often perceived their children to be overweight/obese, and had more impaired family functioning, and less support for changing eating habits and family exercise participation. Patients with impaired family functioning reported less support for changing eating habits and family exercise participation. DISCUSSION Bariatric patients who perceived their child to be overweight/obese and identified as single parents reported more impaired family functioning and less support for eating habits and family participation in exercise. Assessing pre- and postsurgery measures from parents and children will allow the further identification of relationship variables that can be targeted to promote positive family changes that benefit parents and children long-term. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Inadequacy of the PHQ-2 depression screener for identifying suicidal primary care patients.

Abstract: Introduction The Patient Health Questionnaire-2 (PHQ-2) depression screener has been praised for its brevity and ability to identify depressed primary care patients. Additionally, it is often used as the first of a two-step screening process for suicide risk. Despite its decent performance as a depression screener, the PHQ-2 cannot be assumed to be an adequate screener for suicide risk. In the present study, we examine the utility of the PHQ-2 for identifying suicidal patients. Method We examined data from 548 adult primary care patients at a Federally Qualified Health Center in the mid-Southern region of the United States who completed the PHQ-2 as part of the full administration of the Patient Health Questionnaire-9 (PHQ-9). Results Cross-tabulation analyses revealed 22 of the 157 (14.0%) patients endorsing suicidal ideation fell below the conventional clinical cutoff of 3 on the PHQ-2. Logistic regression analyses indicated a positive screen on the PHQ-2 did not improve explanation of suicidal ideation beyond the base model, and only 3 items from the first 8 PHQ-9 questions (depressed mood, feeling like a failure, and psychomotor retardation/agitation) were significant explanatory variables for suicidal ideation. Discussion Providers should consider asking about suicide directly, rather than relying on depression screeners to identify suicidal patients. We also recommend providers pay particular attention to any indication that patients feel like a failure or like they have let their loved ones down, in addition to endorsement of depressed mood. (PsycINFO Database Record

Behavioral medicine interventions for adult primary care settings: A review.

Abstract: Introduction Health care organizations are embracing integrated primary care (IPC), in which mental health and behavioral health are addressed as part of routine care within primary care settings. Behavioral medicine concerns, which include health behavior change and coping with medical conditions, are common in primary care populations. Although there are evidence-based behavioral interventions that target a variety of behavioral medicine concerns, integrated behavioral health providers need interventions that are sufficiently brief (i.e., ≤6 appointments) to be compatible with IPC. Method We conducted a literature review of published studies examining behavioral interventions that target prevalent behavioral medicine concerns and can feasibly be employed by IPC providers in adult primary care settings. Results A total of 67 published articles representing 63 original studies met eligibility criteria. We extracted data on the behavioral interventions employed, results comparing the active intervention to a comparison group, general fit with IPC, and methodological quality. The vast majority of studies examined brief interventions targeting sleep difficulties and physical activity. The most commonly employed interventions were derived from cognitive-behavioral therapy and motivational interviewing. Outcomes were generally statistically significantly in favor of the active intervention relative to comparison, with highly variable methodological quality ratings (range = 0-5; M = 2.0). Discussion Results are discussed in relation to the need for further evidence for brief behavioral interventions targeting other behavioral medicine concerns beyond sleep and physical activity, as well as for more specificity regarding the compatibility of such interventions with IPC practice. (PsycINFO Database Record

Who is meeting the Healthy People 2020 objectives?: Comparisons between racially/ethnically diverse and immigrant children and adults.

Abstract: Introduction To determine the prevalence of reaching multiple Healthy People 2020 (HP 2020) objectives including nutrition and weight status, sleep health, physical activity, health-related quality of life, social determinants of health, and education among low-income, diverse children and adults. Methods Children ages 5- to 7-years-old (n = 150; 47% female) and their parents (mean age = 35; 91% mothers) from 6 racial/ethnic and immigrant/refugee groups (n = 25 from each; African American, Native American, Hispanic, Hmong, Somali, White) participated in this cross-sectional mixed-methods study. Results Overall, the majority of HP 2020 objectives were not being met across this low-income, racially/ethnically diverse, and immigrant/refugee sample of children and adults. In particular, African American children and parents consistently fell below the majority of the HP 2020 targets, with only 5 of the 24 HP 2020 objectives being met. Additionally, immigrant children and parents met less than 2/3 of the HP 2020 objectives. Discussion Concerted public health efforts are needed to address the disparities in reaching the HP 2020 objectives and informing the development of the future HP 2030 objectives among low-income, racially/ethnically diverse, and immigrant children and parents. In order to achieve and assess the current and future HP objectives in these diverse populations, changes may be needed in both interventions and assessment tools. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics.

Abstract: Introduction Use quality improvement methods to implement evidence-based practices for bipolar depression and treatment-resistant depression in 6 Federally Qualified Health Centers. Method Following qualitative needs assessments, implementation teams comprised of front-line providers, patients, and content experts identified, adapted, and adopted evidence-based practices. With external facilitation, onsite clinical champions led the deployment of the evidence-based practices. Evaluation data were collected from 104 patients with probable bipolar disorder or treatment-resistant depression via chart review and an interactive voice response telephone system. Results Five practices were implemented: (a) screening for bipolar disorder, (b) telepsychiatric consultation, (c) prescribing guidelines, (d) online cognitive-behavioral therapy, and (e) online peer support. Implementation outcomes were as follows: (a) 15% of eligible patients were screened for bipolar disorder (interclinic range = 3%-70%), (b) few engaged in online psychotherapy or peer support, (c) 38% received telepsychiatric consultation (interclinic range = 0%-83%), and (d) 64% of patients with a consult were prescribed the recommended medication. Clinical outcomes were as follows: Of those screening at high risk or very high risk, 67% and 69%, respectively, were diagnosed with bipolar disorder. A third (32%) of patients were prescribed a new mood stabilizer, and 28% were prescribed a new antidepressant. Clinical response (50% reduction in depression symptoms), was observed in 21% of patients at 3-month follow-up. Discussion Quality improvement processes resulted in the implementation and evaluation of 5 detection and treatment processes. Though varying by site, screening improved detection and a substantial number of patients received consultations and medication adjustments; however, symptom improvement was modest. (PsycINFO Database Record

To go or not go: Patient preference in seeking specialty mental health versus behavioral consultation within the primary care behavioral health consultation model.

Abstract: INTRODUCTION Much of behavioral health care takes place within primary care settings rather than in specialty mental health settings. Access to specialty mental health care can be difficult due to limited access to mental health providers and wait times to receive mental health care. The purpose of this study is to determine patient satisfaction with behavioral health consultation visits that take place within the context of the primary care behavioral health consultation model. Patient likelihood to seek out specialty mental health care services if behavioral health consultation services were not provided was also examined. METHOD Two primary care clinic systems were examined in this study. The first was a primary care clinic predominately serving low-income patients: 100 individuals participated. The second was primary care in the context of military treatment centers: 539 individuals participated. RESULTS Results show that 61% of the patients in the low-income primary care clinic would not attend a specialty mental health appointment versus 30% in the military population. DISCUSSION This study suggests that primary care behavioral health is a patient-centered approach to care and reaches populations that otherwise may not receive behavioral health services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Use of the WHO’s Perceived Well-Being Index (WHO-5) as an efficient and potentially valid screen for depression in a low income country.

Abstract: Introduction: Depression is associated with negative social, economic, and family outcomes and the majority of individuals with depression in low and middle income countries (LMICs) are untreated. A critical first step in bridging the treatment gap is accurate, feasible, and culturally appropriate screening to identify those who need treatment. The WHO's Perceived Well-Being Index (WHO-5) well-being instrument can potentially meet the screening needs of LMICs in primary care and community-based settings. This study tested the feasibility and validity of this tool to identify depression among adult parents of young children in Addis Ababa, Ethiopia. Successful identification and treatment of depression in parents extends benefits to children and families. Method: The WHO-5 was translated to Amharic and administered to 849 adults and compared with simultaneous administration of the well-established PHQ-9 instrument. Feasibility was assessed and analyses evaluated frequency of positive screens for depression, internal consistency, sensitivity and specificity of the WHO-5, and sociodemographic correlates of depression. Results: The prevalence of probable depression was similar as assessed by the PHQ-9 (17.3%) and the WHO-5 (18.5%). The internal consistency of the WHO-5 was strong (Cronbach's alpha = .83). WHO-5 agreement with the PHQ-9 was moderate; sensitivity and specificity were strong. Correlates of depression included unemployment and financial status. Discussion: The study provides promising evidence to support use of the WHO-5 to identify depression in Ethiopia. Feasibility was good, and it was culturally and linguistically acceptable. The results suggest that minimally trained community health and education workers in countries like Ethiopia could use the WHO-5 effectively in primary health and education settings. (PsycINFO Database Record

Primary care integration in rural areas: A community-focused approach

Abstract: Current and developing models of integrated behavioral health service delivery have proven successful for the general population; however, these approaches may not sufficiently address the unique needs of individuals living in rural and remote areas. For all communities to benefit from the opportunities that the current trend toward integration has provided, it is imperative that cultural and contextual factors be considered determining features in care delivery. Rural integrated primary care practice requires specific training, expertise, and adjustments to service delivery and intervention to best meet the needs of rural and underserved communities. In this commentary, the authors present trends in integrated behavioral health service delivery in rural integrated primary care settings. Flexible and creative strategies are proposed to promote increased access to integrated behavioral health services, while simultaneously addressing patient care needs that arise as a result of the barriers to treatment that are prevalent in rural communities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Health policy brief: Global mental health and the United Nations' sustainable development goals.

Abstract: Introduction Increased awareness of the importance of mental health for global health has led to a number of new initiatives, including influential policy instruments issued by the World Health Organization (WHO) and the United Nations (UN). Method This policy brief describes two WHO instruments, the Mental Health Action Plan for 2013-2020 (World Health Organization, 2013) and the Mental Health Atlas (World Health Organization, 2015), and presents a comparative analysis with the Sustainable Development Goals (SDGs) of the UN's 2030 Agenda for Sustainable Development (United Nations, 2015). Results The WHO's Action Plan calls for several specific objectives and targets, with a focus on improving global mental health governance and service coverage. In contrast, the UN's Sustainable Development Goals include only one goal specific to mental health, with a single indicator tracking suicide mortality rates. Discussion The discrepancy between the WHO and UN frameworks suggests a need for increased policy coherence. Improved global health governance can provide the basis for ensuring and accelerating progress in global mental health. (PsycINFO Database Record

Clinician barriers to initiating sexual health conversations with breast cancer survivors: The influence of assumptions and situational constraints

Abstract: Introduction Sexual health (SH) is an important dimension of physical, emotional, and social functioning after breast cancer (BC). Research suggests that survivors' SH concerns are not being adequately addressed in oncology or primary care settings. It is important to understand why these conversations are not taking place and what can be done to enhance care for women in this context. This research aims to identify when clinicians initiate SH conversations with survivors and to uncover factors that influence these decisions. Method Thirty-six clinicians from family medicine, internal medicine, oncology, and gynecology participated in semistructured interviews. Analysis uncovered themes that influence clinicians' decisions about initiating SH conversations with survivors. Attention was given to capturing the personal, professional, and system-level issues that inform clinicians' communication choices. Results Clinicians reported their decisions are based on (a) beliefs about patients, (b) inability to address survivors' concerns, (c) time constraints that affect the delivery of care, and (d) views of professional function in survivor health care. Discussion Clinician decisions are based on sometimes-erroneous assumptions and situational constraints. This suggests the need for medical education and support regarding SH care. Several practice points are outlined to facilitate clinicians' efforts to improve SH care for female BC survivors. (PsycINFO Database Record

Examining family and neighborhood level predictors of sleep duration in urban youth.

Abstract: INTRODUCTION Shortened sleep duration in adolescence has been found to be associated with adverse health outcomes. While several studies have explored individual predictors, few have examined the role of neighborhood-level factors, family, and peer contexts as predictors of sleep among adolescents. METHOD We examined contextual factors of sleep duration in a sample of 1,614 urban, public high school students from the 2008 Boston Youth Survey. Neighborhood data came from the 2008 Boston Neighborhood Survey of 1,710 adult Boston residents, the 2009 American Community Survey Census (ACS), and Boston Police. RESULTS Using multilevel linear regression, adjusting for neighborhood and school clustering, age, race, and sex, we found concentrated neighborhood poverty to be positively associated with sleep duration (β = 0.09, p = .03). Family context was significantly associated with longer sleep duration: >1-3 hr of homework per night reported longer sleep compared with students reporting ≤1 hr per night (β = 0.20, p = .005). Students reporting lower levels of positive parenting influence had shorter sleep duration (0-25th percentile: β = -0.25, p = .01; 26th-50th β = -0.24, p = .03), compared with students in the highest percentile. Students who never ate dinner with family had shorter sleep duration as compared with those having dinner with family 5 or more times per week (β = -0.22, p = .05). DISCUSSION Our findings focusing on neighborhood and family context represent potentially modifiable practices. These finding are important for public health advocates and health care providers as they seek to curb the epidemic of sleep deprivation in youth. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Assessing social determinants of health in primary care: Liability or opportunity?

Abstract: Health care is never boring. It changes rapidly based on political winds, financial models, novel terminology, and biomedical advances. In the past decade, there has been large-scale implementation of integrated health care, routine screening for common behavioral health conditions, and the rollout of alternative payment models in primary care. However, even before these advances have been inculcated as the standard of care, we are now witnessing the implementation of health coaches and recommendations to screen for social determinants of health. Social determinants of health (SDOHs) include nonclinical factors that impact health, such as income, education, and the social the conditions in which people are born, grow, live, work and age. While there is strong evidence that health outcomes are only marginally determined by direct clinical care and largely determined, it is unclear what "system of care" (public health vs. medical care) bears the responsibility of identifying and addressing these issues. Is this really the responsibility and role of primary care? Whether we as a health care system decide that systematically asking about and addressing SDOHs is within our job descriptions remains to be seen. Further research is needed to determine the cost and clinical impact of screening and addressing SDOHs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Integrated care models for ADHD in children and adolescents: A systematic review

Abstract: Introduction Attention-deficit/hyperactivity disorder (ADHD) in children and adolescents is commonly managed in primary care. Changes in United States health care have led to the integration of behavioral health services within a patient's "medical home" to improve access to, engagement in, and continuity of quality health care. Despite proliferation of these integrated care models, no studies have specifically examined models for managing ADHD in children and adolescents within primary care. Method We searched PsycINFO, MEDLINE, and Google Scholar databases, and found 8 studies describing 6 integrated care models (i.e., combined psychosocial and medication treatments with coordination of care between primary care clinicians and behavioral health clinicians). We reviewed characteristics (i.e., settings, target populations, providers, levels of integration, evaluation and treatment approaches, and methods of interprofessional collaboration) and outcomes (i.e., access, outcomes, and acceptability) of these models. Results The 6 integrated care models demonstrate the potential to improve access to and acceptability of ADHD care for children and adolescents. The models also demonstrate that behavioral health clinicians can integrate at various levels within primary care to achieve superior clinical outcomes compared with nonintegrated models. Discussion We identified 6 effective integrated care models for addressing ADHD in children and adolescents that may be adaptable to local needs and internal capacities. We discuss results of these models with regard to their implications for clinical practice and research. (PsycINFO Database Record

Coping strategies and support structures of addiction affected families: A qualitative study from Goa, India.

Abstract: Introduction Despite the large burden of a relative's drinking on their family members, the latter's perspectives and experiences are largely neglected. The aims of this article are to assess the coping strategies used by affected family members (AFMs) in Goa, India, and to examine the nature of the support they have for dealing with their drinking relative. Method In-depth interviews were conducted with adult AFMs selected through purposive and maximum variation sampling. Data was analyzed using thematic analyses. Results The commonly used coping strategies included accommodating to the relative's behavior, financially adapting to their means, self-harm, attempting to reason with the drinking relative, covert intervening, and avoiding fights and arguments. There was a general reluctance to seek support, and the type and quality of support that was available was also limited. Support from neighbors or relatives was primarily through providing a "listening ear" or financial support. Religious and spiritual pursuits were commonly used to seek solace, and to manage negative thoughts and feelings. Formal support was sought for themselves or the relative through existing health services and Al-Anon, and occasionally from the police. Discussion AFMs experience a considerable amount of strain in relation to their relative's drinking, and have to rely on different ways of coping and social support, as is available to them. Although there is a universality to the experiences of families affected by addictions, this must be interpreted with caution, as it is also accompanied by variations in cultural factors related to these experiences. (PsycINFO Database Record

The role of partner autonomy support in motivation, well-being, and weight loss among women with higher baseline BMI.

Abstract: Introduction The association of partner autonomy support with women's motivation for healthy eating, weight-related health behavior change, and psychological well-being has been largely overlooked. Results of 2 studies showed that the positive association between autonomy support and a variety of motivational and psychological outcomes was especially pronounced for women with high body mass index (BMI) (+1 SD) compared to low BMI (-1 SD). Method In Study 1, autonomy support was measured as male partners' report of their behavior in a cross-sectional design. In Study 2, autonomy support was measured as female participants' perceptions of their partners' behavior in a longitudinal home environment-based behavioral weight loss intervention. Results Study 1 showed that autonomy support from partners was associated with greater self-determined motivation for healthy eating and self-reported well-being among women with higher BMI. Study 2 showed that changes in partner autonomy support over 18 months of a home-based weight loss intervention were associated with increases in motivation for treatment and greater weight loss, especially for women who had higher baseline BMI. Discussion Both studies demonstrated that autonomy support was associated with adaptive functioning across weight status but that it was especially potent for women with higher BMI. This pattern of findings is explained in terms of the pressures women with higher BMI may feel about their weight-related behaviors. (PsycINFO Database Record

Achieving same-day access in integrated primary care.

Abstract: Same-day access to behavioral health services is a critical feature of integrated primary care. Despite the benefits of same-day access, implementing and sustaining this key feature has been a challenge for multiple health care settings. Further, there is relatively little practical guidance on how to implement this practice management feature. Diverse program design solutions for same-day access are implemented in clinics across the Veterans Health Administration. The authors identified innovative approaches, developed in local facilities, with demonstrated success in same-day access that can be implemented in any setting. The purpose of this article is to describe five approaches for providing same-day access within integrated care. The authors discuss key considerations (staffing, space, program maturity), potential challenges and facilitators, and provide practical recommendations for implementation. (PsycINFO Database Record

Introducing supported self-management for depression to primary care in Vietnam: A feasibility study in preparation for a randomized controlled trial.

Abstract: INTRODUCTION Although depression is a major contributor to the global burden of disease, services remain scarce in many low- and middle-income countries. In Vietnam, depression services are limited, and the government has recently prioritized primary care and community-based service integration. We conducted a pilot study in 2 districts of Hanoi to test the feasibility of (a) introducing a supported self-management (SSM) intervention for adult depression in primary care in Vietnam, and (b) conducting a randomized controlled trial (RCT) to test the effectiveness of the intervention. METHOD We conducted focus groups with providers (n = 16) and community members (n = 32) to assess the appropriateness of an Antidepressant Skills Workbook for use in Vietnam. We trained providers (n = 23) to screen patients using the Self-Reporting Questionnaire-20 (SRQ-20) depression scale and to deliver SSM for a 2-month period. A total of 71 patients were eligible to participate in the study, with depression (SRQ-20) and disability (World Health Organization Disability Assessment Schedule 2.0) scores assessed at baseline and 1 and 2 months. RESULTS Study results demonstrate the feasibility of conducting a full RCT in Vietnam and suggest that SSM is an appropriate care model for the Vietnamese context. There was a statistically significant decrease in depression symptoms on the SRQ-20 and in functional disability in all domains for the World Health Organization Disability Assessment Schedule 2.). CONCLUSION Feasibility study results suggested that a full RCT was warranted. An unanticipated outcome of the study was the uptake of the model by the Ministry of Labor, Invalids, and Social Affairs in 2 additional provinces. (PsycINFO Database Record

Enhancing residents' compassionate communication to family members: A family systems breaking bad news simulation.

Abstract: Introduction Surgical residents often need to break bad news (BBN) to patients and family members. While communication skills are a core competency in residency training, these specific skills are rarely formally taught. We piloted a simulation training to teach pediatric surgical residents how to compassionately BBN of an unexpected, traumatic pediatric death to surviving family members. This training was unique in that it was influenced by family systems theory and was a collaborative effort between our institution's surgery residency and medical family therapy (MedFT) programs. Method This study provides outcomes of surgery residents' communication skills, attitudes, and self-perceptions after a BBN simulation activity with standardized family members at a major academic teaching hospital. Each resident participated in two 30-min simulations and received feedback from observers. Outcome data were collected through self-assessments completed before, immediately after, and 6 months after the simulation. Participants were 15 surgery residents, and MedFT students served as simulated family members and trainers. Results A statistically significant change with medium to large effect sizes in participant self-reported perceptions of skill and confidence were documented and maintained over 6 months. Responses to open-ended questions supported practice changes in response to the training. Discussion This collaborative training promoted significant improvement in resident compassionate communication skills. The curriculum was highly valued by the learners and resulted in sustained application of learned skills with patients and families. Our novel approach was feasible with promising results that warrant further investigation and could be reproduced in other institutions with similar programs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A vision for the future of Families, Systems, & Health: Focusing on science at the point of care delivery.

Abstract: The authors are pleased to introduce themselves as the new co-editors. They are Nadiya Sunderji and Jodi Polaha, midcareer academic clinicians whose careers have balanced research, teaching, and clinical practice in integrated care. They continue the Families, Systems, & Health (FSH) tradition of interprofessional co-editor teams (Dr. Sunderji is a psychiatrist and Dr. Polaha is a psychologist) and add a new twist: international collaboration. Dr. Sunderji is Canadian, and they welcome the new contributors and readers this collaboration will bring. The authors thank those who worked so diligently to develop a strong journal with a tradition of contributing important work in health care. They thank outgoing Associate Editors, Drs. Douglas Brock and Todd Edwards, as well as outgoing Department Editors, Drs. Ben Miller and Randall Reitz, who served the journal faithfully for many years. They also note that in 2003, Zerhouni (2003) laid out a roadmap for research in the journal Science, using a bridge as a metaphor to explain how scientific infrastructure (journals, grants, training, and the development and dissemination of advanced scientific methods) supports the translation of knowledge from bench to bedside. The authors borrow the bridge metaphor here to discuss the direction for FSH under their leadership. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A review of published guidance for video recording in medical education.

Abstract: Introduction Medical educators have used resident-patient video recording to verify trainee competence in interpersonal and technical skills for 50 years. Although numerous authors acknowledge that video recording can compromise patient privacy and confidentiality, no summary of potential risks is available. Method A scoping review of the literature on resident-patient video recording in medical education from the 1960s to the present was conducted. The review examined publications that addressed ethical, policy, procedural, or legal issues affecting patients' rights when video recording. Results Potential risks to the rights of video recorded patients were organized into 6 categories: informed consent policies, informed consent procedures, recorded medical errors, secondary use of recordings, collateral patient information, and public trust issues. The review revealed contradictory opinions on informed consent policies, inadequate guidance for responding when medical errors are recorded, and conflicting opinions about when recordings become part of the medical record. Many reviewed publications are opinion-based, precede current confidentiality guidelines, or rely on survey results. Discussion This review organizes potential threats to patients' rights for those medical educators who use video recording technology. The review reveals a need for broader consensus about video recording guidelines and for research on video recording practices, especially given technological advances in video equipment and the expansion of video technology in health care settings. (PsycINFO Database Record

Mother-father-adolescent triadic concordance and discordance on home environment factors and adolescent disordered eating behaviors.

Abstract: Introduction This study utilizes triadic data to examine the association between mother-father-adolescent concordance (agreement) and discordance (disagreement) on home environment factors (i.e., parental encouragement of dieting, family functioning) and adolescent unhealthy weight control behaviors and binge eating. Method A subsample of adolescent-mother-father triads (n = 833; adolescents ages 10-22) from two coordinated population-based studies (EAT 2010 and F-EAT) were used. Poisson regression analysis was used to estimate the relative risks of each eating disordered behavior. Results Triads were more concordant (range 9-42%) than discordant (range 4-24%). Triadic agreement that parents did not encourage dieting was associated with a lower risk of adolescent eating disordered behaviors in some triadic combinations. Additionally, triadic concordance on high family functioning was also associated with a lower risk of adolescent eating disordered behaviors among some triadic combinations. Discussion Results suggest that triadic concordance on healthy home environment factors is associated with fewer adolescent disordered eating behaviors in some triads. Family based interventions may want to consider focusing on strategies to help move mother-father-adolescent triads closer on seeing the home environment more similarly. Future research is needed on triadic concordance/discordance and disordered eating behaviors to confirm study results and to inform the development of family based interventions. (PsycINFO Database Record

Global proofing a collaborative care telemental health intervention in Brazil

Abstract: Rural proofing ensures that policies, practice guidelines, strategies, and techniques can be applied to rural populations with approximately equal benefit as what would be obtained in urban areas. Extending this concept internationally, the authors argue the importance of global proofing mental health strategies developed in well-resourced, high-income areas in order to determine their appropriateness in areas that have resource poverty such as middle- and low-income countries. An example is used to illustrate both rural and global proofing. Through this example, the authors demonstrate how they proofed urban-inspired models of mental health care in rural areas of the United States. The result is a model of rural mental health care that emphasizes collaborative care and telemental health. This model is now being global proofed in Brazil. The authors describe the application of this model in a remote rural town in Brazil. Consistent with World Health Organization recommendations, the integration of mental health care into primary care medical settings is being discovered as essential to addressing mental health disparities worldwide. (PsycINFO Database Record

Is relationship quality linked to diabetes risk and management?: It depends on what you look at.

Abstract: Although the quality of marriage and marriage-like relationships (e.g., cohabitation) has been linked to the risk of developing diabetes and being able to effectively manage the disease once developed, it is unclear which aspects of marital quality drive these associations. Method Using nationally representative data (Midlife in the United States, N = 800), the present study therefore examines how aspects of marriage (e.g., strain, support, marital risk, and constructive communication) are linked to diabetes outcomes and whether these links vary as a function of sociodemographic characteristics related to health (e.g., gender, race, and income). Results Strain and marital risk were linked to an increased risk of developing diabetes and strain and poor communication were linked to an increased risk of poor diabetes management. Finally, marital support was linked to a lower risk of diabetes but only for those with lower income. Discussion These findings inform prevention and intervention programs focusing on social support mechanisms to potentially reduce the risk of developing diabetes (e.g., reduced marital strain and marital instability) and improving diabetes control (e.g., improved communication and reduced marital strain). (PsycINFO Database Record

Autism spectrum disorder in Latin American families: Experiences in Chile.

Abstract: Introduction The present study provides pilot data investigating relationships between severity of autism spectrum disorder (ASD) traits, community supports, and other family variables as reported by caregivers of children with ASD in Chile. Method An anonymous caregiver survey was developed based on previous ASD survey studies conducted in the United States and direct input from collaborators residing in Chile. Participants included Chilean caregivers of individuals with ASD (N = 50; Mchild age = 6.98). The survey addressed topics regarding the child's ASD traits, the caregiver's beliefs and perceptions of ASD, and community supports and engagement. Results Correlational analyses indicated associations between ASD traits, physician support, family stress, stigma, and community engagement. Discussion Results from this study highlight the importance of future research to better understand and treat Latin American children with ASD and their families. (PsycINFO Database Record

An introduction to global mental health.

Abstract: In general, readers of Families, Systems, and Health (FSH) practice in high income countries and in settings that have adequate resources. Providers can usually count on being able to offer the material resources and skills that patients need to heal. This bounty of resources is in contrast to many clinics in low- and middle-income countries (LMICs). The need for mental health services in LMICs is significant and growing because of upheaval caused by war and other disasters. The topics in this issue talk about the obstacles to obtaining mental health services, trends in global mental health, and FSH in the global mental health movement. (PsycINFO Database Record

Parent-adolescent dyadic diabetes distress: Associations with A1c and diabetes-related strengths.

Abstract: INTRODUCTION This study examined concordance and discordance between parent-adolescent report of diabetes-specific emotional distress and associations with A1c and diabetes-related strengths. Diabetes strengths refer to adaptive behaviors and attitudes that enhance resilience in living with diabetes. METHOD One thousand two hundred sixteen adolescent-parent dyads completed measures of diabetes distress and adolescent-reported diabetes strengths. Polynomial regression with response surface analysis assessed concordant and discordant reports of adolescent-parent distress and independent associations of each reporter's distress on measures of diabetes strengths and A1c. RESULTS A1c was lower in concordantly lower distress dyads compared to concordantly higher distress dyads. For discordant dyadic reports, A1c was higher when distress was higher for parents and lower for adolescents compared to low-parent-high-adolescent distress. Greater diabetes-related strengths were reported when distress was concordantly low among dyads and fewer strengths were reported when distress was concordantly higher. Greater strengths were reported when distress was lower for adolescents and higher for parents compared to high-adolescent/low-parent distress. Dyadic distress for both A1c and diabetes strengths were robust when adjusted for significant demographic predictors of outcome including age, race, income, pump use, and continuous glucose monitoring use. DISCUSSION A1c and diabetes strengths are associated with degree of concordant and discordant reports of diabetes distress among adolescent-parent dyads. Programmatic interventions should target parents and adolescents, particularly when diabetes distress is higher among both adolescents and their parents. (PsycINFO Database Record